The Government Accountability Office (GAO) June 26 released its report, “Physician Workforce: Locations and Types of Graduate Training Were Largely Unchanged, and Federal Efforts May Not Be Sufficient to Meet Needs.” The report examines the changes in the number of residents in graduate medical education (GME) training by location and type of training from 2005 to 2015, as well as the federal efforts to increase GME training in rural areas, and in primary care.
The report finds that the locations and types of residents were largely unchanged from 2005 to 2015 with a large percentage concentrated in the Northeast. Although there was some growth in rural areas, 99 percent of residents trained in urban areas. The South saw the largest percentage of GME resident growth over the time period (28 percent) while the Northeast only saw resident growth of 15 percent. According to the report, “Of the 3,143 counties in the United States, in 2015, residents were located in 444 counties. However, about half of residents were located in 31 counties.”
Additionally, the report finds that federal efforts to increase GME training in rural areas consisted mostly of higher payments to hospitals providing the training, but some Medicare GME payment requirements may actually be a barrier to more widespread use of the increased funding. Of the rural hospitals, only 49 hospitals (seven percent) reported having GME training, as opposed to 26 percent of hospitals overall. The report details some of the challenges presented with offering GME training in rural areas specifically related to Medicare payment requirements. In particular, the report states “…officials told us that the way a hospital’s resident [full-time equivalent] FTE caps are established, as well as the amount it is paid per-resident for [direct graduate medical education] DGME, may make rural hospitals hesitant to partner with urban hospitals to provide GME training.” In 1997, Congress capped the number of residents each teaching hospital can claim for Medicare GME payments at the number the hospital trained at the end of 1996.
Finally, the report finds that federal efforts to increase primary care GME training, while successful in adding residents, accounted for a low percentage of total residents. These efforts include the Teaching Health Center program (557 residents), the Primary Care Residency Expansion Program (500 residents), the [Veterans Affairs] VA GME expansion (366 FTEs), and the Medicare GME redistribution (599 FTEs for [indirect medical education] IME, 692 FTEs for DGME). Of these efforts, evidence collected from the Teaching Health Center and Primary Care Residency Expansion programs suggested that many of their residents will practice in primary care.
In conclusion, the authors of the report echoed a recommendation made in 2015 by the GAO that the Department of Health and Human Services develop a comprehensive and coordinated planning approach to ensure that workforce efforts meet national needs.