Experts agree: The country’s graduate medical education (GME) system needs an overhaul. Many groups have outlined proposals to fix the system, but which solutions will be best?
With the National Resident Matching Program’s (NRMP) match a month away, and the recent American Osteopathic Association (AOA) Intern/Resident Registration Program match completed last week, the future of GME is at the forefront right now. The system’s problems received national attention last year after the long-awaited report from the Institute of Medicine (IOM) called for transitioning the current system to a transparent, performance-based system. While the AMA agreed with many of the report’s provisions, the IOM didn’t recommend adding funds to protect against looming physician shortages—a fact that concerned the AMA.
Physicians at the 2014 AMA Annual Meeting voted to investigate new solutions for workforce expansion, again calling for innovative ideas based on a report from the AMA Council on Medical Education. More recently, in a letter to the House of Representatives Committee on Energy and Commerce, the AMA outlined key reforms for an improved GME system:
- Remove the existing cap on publicly funded residency positions. This policy, based on statistics from 1996, no longer accurately reflects current patient needs, regional demands and access to certain specialties. Without the cap, training programs could expand or contract over time, aligning with patient and population needs and changes in local priorities.
- Increase the number of GME positions to ensure access to care. Workforce experts predict a shortage of more than 45,000 primary care and 46,000 specialty physicians in the United States by 2020. In response to this impending shortage, medical schools have increased overall enrollment by nearly 28 percent, but residency positions have not kept pace.
- Promote educational experiences in the broadest range of sites. Innovative practice models are developing across the country, and residency programs should reflect all practice settings. “GME funding should support a broad range of clinical experiences available in both rural and urban settings,” the letter said, including hospital and ambulatory settings “so residents can learn to practice in a variety of care environments and care for diverse patient populations.”
- Explore additional sources of GME funding, including states and all-payer models. Innovative solutions such as the Creating Access to Residency Education (CARE) Act, which would authorize $25 million in grants for new GME positions in states with a low ratio of medical residents, are needed, the letter said. “For many years, the AMA has urged that not only states, but all relevant payers and stakeholders play a role in funding GME,” it said. “An all-payer system would expand resources so that all training programs, regardless of location, receive adequate funding.”
At the conclusion of last year’s NRMP match, 5.6 percent of U.S. allopathic medical school seniors were not placed into first-year residency programs, while more than one-half of applicants who already graduated from these schools did not match. At the same time, match rates rose modestly for all major applicant groups. Last week’s osteopathic match placed 75 percent of DO students.
The AMA is addressing this issue by continuing its advocacy for additional GME funding and for programs in rural and underserved locations. In addition, the AMA is working with stakeholder groups to reduce restrictions to rural and other underserved community experiences for GME programs and encouraging innovative ways to train physicians, with emphasis on physician-led, team-based care.
Students and residents also are advocating for expanded GME programs, using social media and other tools to call on Congress to #SaveGME, including a weeklong grassroots campaign.
Tell us: How would you fix the country’s GME system? Tell us in a comment below or on the AMA Facebook page.
