June 29, 2001
GME Focus of Policy Forum Discussion
Graduate Medical Education (GME) was the focus of a June 22 discussion of the National Health Policy Forum, a popular nonpartisan information exchange for federal health policy makers and congressional staff sponsored by George Washington University. Moderated by Sheila Burke, presentations were made by Thomas Oliver, Ph.D. and Atul Grover, M.D., from Johns Hopkins University, Edward Salsberg, from the Center for Health Work Force Studies in Albany, NY, and Barbara Wynn from the RAND Corporation. Robert Dickler, senior vice president of the Association of American Medical Colleges and Dan Nickelson of the Cleveland Clinic provided commentary on the presentations.
The Forum discussion was far ranging, including discussions about variations in Medicare direct graduate medical education (DGME) and indirect medical education (IME) payments, state-level initiatives in funding GME, and the various missions of teaching hospitals-including the provision of uncompensated care.
While no consensus emerged from the meeting, several important issues were raised:
In terms of the last point on teaching institutions receiving the same "average" payment, one observer asked whether such averaging is appropriate given that a hospital with 300 residents is undoubtedly very different than a hospital with 8 residents. Observers also noted that teaching hospitals provide a "joint product" of education, research, and patient care, which makes it difficult to quantify the value of these products individually.
- What are GME payments intended to purchase? (i.e., what do we as a society want to "buy" in terms of physician education and the special missions of teaching hospitals?)
- Should Medicare be a financing source for the goal(s) in bullet one? What other finance streams should be considered in addition to, or in lieu of, Medicare?
- How much variation across institutions should there be in terms of Medicare DMGE and/or IME payments?
Information: Robert Dickler or Karen Fisher, AAMC Division of Health Care Affairs, 202-828-0490.
