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Senators Want an In-Depth Look at Graduate Medical Education

By Jane Norman, CQ HealthBeat Associate Editor

December 22, 2011 – Seven senators from both sides of the aisle are asking the Institute of Medicine to do a thorough review of the nation's system of graduate medical education that funds medical residencies.

It's an indication of the growing interest in Congress in shaping the future of the physician corps as the health care law (PL 111-148, PL 111-152) is implemented with its emphasis on coordinated care and primary care. According to the Association of American Medical Colleges (AAMC), there's been "no appreciable increase" in the median number of active primary-care physicians per 100,000 population between 2008 and 2010.

In a letter to the IOM, the senators said they would like to see an independent review of the governance and financing of the GME system, including inequities in funding across states based on their needs and capacity.

"We believe our GME system is under increasing stress and the projections for our health care workforce are of significant concern," the letter said. "There is growing concern that the United States is failing to adequately match medical training with our medical needs on a national level."

It was written by Democrats Jeff Bingaman and Tom Udall of New Mexico and Mark Udall and Michael Bennet of Colorado, and Republicans Jon Kyl of Arizona, Charles E. Grassley of Iowa and Michael D. Crapo of Idaho.

Western states, such as those represented by the senators, tend to have fewer physicians and fewer students enrolled in GME programs compared with states in the Northeast, according to data from the AAMC.

Funding for GME and the training of doctors has been a hot topic especially after the Medicare Payment Advisory Commission (MedPAC) made recommendations on how training could be improved to upgrade the nation's physician corps.

Commissioners have raised questions about whether the way doctors now are trained is effective at producing physicians who focus on information technology, integrated care and other approaches needed for changes in the health care delivery system.

This year GME came under scrutiny again when President Obama in his 2012 budget proposal eliminated the children's hospital GME program, which provides funds to 56 children's hospitals across the nation and trains pediatricians as well as pediatric subspecialists.

The program, however, was spared in the 2012 omnibus spending bill (HR 2055). The AAMC has appealed to lawmakers to avoid further cuts to training.

The letter from the senators says that changes to GME are under discussion in Congress, at MedPAC, at the Accreditation Council for Graduate Medical Education and at various foundations.

In September, the Josiah Macy Jr. Foundation reported that a "compelling case" is made for changes in how training is conducted. "Changes in demographics and disease patterns and increasing health disparities create new health care needs, requiring new approaches to physician education that emphasize collaboration, communication, and transitions in care," the report said.

"The public expects the GME system to produce a physician workforce of sufficient size, specialty mix, and skill to meet society's needs," the report said. "Many observers from both public and professional vantage points feel it is currently falling short in each of these dimensions."

The senators echoed that conclusion. "It is time to redesign health care workforce education and training in a manner that improves access to and delivery of health care services and enables the future generation of health care professionals to actively participate in creating high-quality, lower-cost health care," they said.

They also said they want analysis of areas including accreditation, reimbursement policy and the care of the underserved, and they would like to see recommendations from IOM by the third quarter of 2012.

According to AAMC, there were 258.7 active physicians per 100,000 population in the United States in 2010. The figures ranged from 415.5 in Massachusetts to 176.4 in Mississippi. States in the Northeast had the highest concentrations of physicians.

There were 90.5 primary-care physicians per 100,000 population nationally, with the highest number per population in Massachusetts and the lowest in Mississippi.

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