Graduate Medical Education (GME) is in need of changes that address the rapidly changing health care system and to better prepare physicians-in-training for the future. A new report asked physicians, residents and other stakeholders from around the nation to identify GME-related issues or concerns.
A recent report from the Association of Academic Health Centers brings together the input of physicians and residents, several medical societies, accreditation bodies, regional experts and other organizations with GME interests to discuss the current state of GME and what changes could be made to meet future health care needs.
What needs to change about GME
The roundtable discussions had similar themes across the board and pointed out the specific areas where changes to the structure and strategy of GME could lead to enhanced residency programs and better prepared physicians.
Here are six of the themes that appeared in the discussions:
- Organizational conflict between teaching hospitals and medical schools. Because teaching hospitals are the recipients of most Medicare GME funding, conflict between those hospitals and the medical schools responsible for the teaching and accreditation of the programs was a key factor throughout the roundtables. Participants identified a clear lack of alignment in organizational missions, a lack of transparency in approaches and disparate yet overlapping areas of responsibility. “The overall funding of GME may need to be changed in order to adequately address the organizational conflict,” the report said.
- Private sector influence on the health care system. Roundtable participants said that market forces are driving a lot of the changes in the health care system, yet they also stated they feel unfamiliar or disconnected with entrepreneurial activity being done that will impact GME training programs. There was also recognition that entrepreneurs in the private sector could be very helpful in filling some of the training gaps where current programs do not have appropriate expertise or time to provide additional training. Learning from the private sector could enhance GME programs.
- Mental health and well-being of residents. Issues of mental health and wellness were identified in all discussions and residents were recognized as having an increased desire for confidential and easily accessed mental health resources in recent years. Factors contributing to this problem were also identified and include limited time off, increased responsibilities with fewer resources, threatened job satisfaction and more stress. Wellness programs were recognized as a critical and currently lacking component of GME programs for both faculty and residents.
- Revisions to program and accreditation structure. In every session, participants discussed the need for revisions to the structure of GME programs and the accreditation entities that incentivize and drive that structure. “The overwhelming consensus view was that medical schools need much more flexibility to properly train physicians of the future,” the report said. “If academic health centers were able to tailor programs to both medical students’ and residents’ areas of interest, the length of time of medical education, as well as the cost, might be significantly reduced.”
- Addressing difficulties providing health care to rural and underserved areas. Roundtable participants identified a need for training in environments in which future physicians will practice, rather than a one-size-fits-all approach in the clinical/hospital environment. It was also recognized that there is an overall shortage of physicians, residents and teaching faculty in rural and underserved areas due to lower salaries, which increases the challenges in repaying tuition debt, as well as a lack of opportunities for families. Technology, including telemedicine, was seen as a possible solution in this area, the report said. “However, it was emphasized that the current funding, reimbursement and regulatory schemes do not currently support the use of technology in many instances.” Greater inclusion of interprofessional partnerships and training were pointed to as critical for addressing limitations in current programs.
- More health care workforce planning is needed. Comprehensive and accurate workforce analyses were felt to be essential for a successful GME strategy. Workforce planning must be sufficient and focus on all health care providers, not just physicians. “Accreditation programs could be fashioned in such a way as to promote and support workforce needs in line with a comprehensive strategy,” the report said.
On the matter of GME funding and further reform
Though the current structure of GME funding was intentionally left out of the discussions, it was clear to researchers that all participants believed that it is essentially broken. “There was a strong consensus that reworking the funding mechanism for GME could ameliorate a number of the issues raised,” the report said. “If designed properly, [a new funding structure] could facilitate GME programs that better fit today’s health care marketplace, enhance the roles of academic health centers … in residency programs, and support the changing health care delivery systems to support patient needs.”
The roundtables were conceived in response to a 2014 National Academies of Sciences, Engineering and Medicine (formerly the Institute of Medicine) report that called for transitioning the current GME system to a transparent, performance-based system.
The AMA has long advocated for and adopted numerous policies and reports that support the modernization of GME, including a report on the physician workforce shortage and approaches to GME financing (log in). At this year’s AMA Annual Meeting, delegates adopted policy to advocate for the appropriation of Congressional funding in support of the National Healthcare Workforce Commission, established under the Affordable Care Act, to provide data and healthcare workforce policy and advice to the nation and provide data that support the value of GME.
Recently, the AMA supported the Creating Access to Residency Education Act (CARE) to expand funding for GME and improve access to health care for patients in underserved areas. The organization also supports the Resident Physician Shortage Reduction Act of 2015, to help increase the number of residency slots and address physician shortages.
The Accreditation Council for Graduate Medical Education (ACGME) recently launched the Physician Well-Being initiative, intended to create a learning environment that recognizes physician well-being as critical to their ability to deliver the safest, best possible care to patients. Also, the ACGME earlier this year announced its Pursuing Excellence in Clinical Learning Environments initiative.
Through its SaveGME campaign, the AMA continues to strongly urge Congress to protect federal funding. The campaign website offers many resources and ways to take action to improve GME.
The AMA’s Accelerating Change in Medical Education initiative is also addressing some of these issues by supporting medical school projects that accelerate student progress, allowing them to enter residency sooner and contribute more rapidly to expanding the physician workforce. Learn how medical schools are embedding students in real world environments to enhance the learning process.
