Graduate Medical Education Funding Showdown?

Oct 9, 2012

The Association of American Medical Colleges has launched a new ad campaign, running in newspapers near the sites of upcoming presidential debates, calling for an increase in funding for graduate medical education. The group is trying to draw attention to what it sees as a crisis in the making: the current limit on the number of federally funded residency programs could, it says, lead to doctor shortages. It's just the latest in a series of movements on the GME front. And some believe it's going to come to a head on Capitol Hill after the November election.

Future Docs will definitely be exploring funding for graduate medical education in features, interviews, and more blog posts. But here's the issue, in a nutshell:

  • Medical students complete four years of training in school, get their medical license (if they pass the exams, of course), and then go on to do typically four years of training as a resident in a teaching hospital. A couple of sources have told me it costs about $100,000 a year to train each resident.
  • There's a debate going on over who should pay for that training, and how much. Right now, it's a mix of public and private money, with most of it coming from the federal government in the form of Medicare funds. The rest comes from state Medicaid dollars, a few other federal agencies, and via private insurers (like Blue Cross Blue Shield Rhode Island) in the form of the often higher (but controversially so) payments it negotiates with teaching hospitals that take on the extra cost not only of training residents but of caring for their typically poorer and sicker patient population.
  • That funding has seen several recent challenges from the executive branch. And on the legislative side, several bills have recently been introduced that would fundamentally alter the way we pay for GME. These include the Resident Physician Shortage Reduction Act (re-introduced in Sept. 2012) and the Graduate Medical Education Reform Act, introduced in May by Rhode Island's own Sen. Jack Reed, which would tie a hospital's GME payments to its performance on certain patient care measures (like coordination of care and the use of electronic health records). I'm betting no action will be taken on these measures until after the November election.
  • What's more, in 1997, Congress capped the number of Medicare-funded medical residency spots at 115,000. That was based on the number of residents teaching hospitals had on staff the prior year. It hasn't been lifted since. According to a policy briefing from the Robert Wood Johnson Foundation, some hospitals have received exemptions, and overall spending on graduate medical education has steadily increased since then.
  • Many professional organizations, including the American Medical Association, have expressed concern about the cap's potentially hindering our ability to meet the growing demand for physicians. The idea is that the Affordable Care Act will expand the number of people who have insurance, upping the demand for doctors. Add to that a growing number of older people needing complex medical care, record numbers of new applicants to medical schools, and a number of new medical schools slated to open in the near future. Are we headed for a glut of doctors who can't get the training they need?