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Federal Advisory Body Releases GME Report

December 5, 2014—An advisory body to the Secretary of Health and Human Services and Congress describes in a Nov. 26 report challenges and opportunities with respect to enhancing graduate medical education (GME), particularly as the healthcare system evolves.

In its 22nd report, “The Role of Graduate Medical Education in the New Health Care Paradigm,” the Health Resources and Services Administration (HRSA)’s Council on Graduate Medical Education (COGME) reaffirms its past findings that federal GME investments should increase above current levels. The council also expresses reservations about proposals to redirect or cut existing investments, such as recommendations by an Institute of Medicine (IOM) committee to eliminate Medicare Indirect Medical Education (IME) payments [see Washington Highlights, Aug. 1].

The report explains, “The IOM Committee draws on past analyses finding that much of IME is not devoted to training and could be cut without harming the programs. However, COGME believes that IME funding helps support programs and activities that serve an important public health need. These funds may be inextricable from the maintenance of training programs.”

Indicating support for transparency in such clinical care payments, the report also warns, “An across the board reduction in these amounts would significantly disadvantage patients and communities as well [as] GME trainees by reducing access to much-needed medical specialty care, particularly in disadvantaged and underserved communities.”

Similarly, the council acknowledges the logistical complexities associated with drawing conclusions about expenses and investments in physician training. It states, “Transparency around the allocation of federal support, how programs use such funds, and the outcomes they achieve, could inform policy and drive program performance. However, linking program cost information with outcomes metrics requires a level of financial disclosure that even the most forth-coming training programs may find difficult, if not impossible, to provide.”

In terms of programmatic enrichments to GME, the report recognizes that opportunities exist to improve “investment in innovation, research, and workforce analysis,” but “COGME questions the wisdom of diverting significant amounts of present educational funds to support these activities.”

While the council sees value in increasing training opportunities in outpatient settings, the advisory body also highlights hurdles that must be overcome to achieve such goals. The report describes, “Recruiting physician faculty for new programs in community and ambulatory settings is challenging because the community physicians feel it is difficult to devote the time to teaching, at the expense of reduced practice income and decreased clinical productivity. Faculty members are also concerned that they lack the expertise in teaching methodologies to assure quality educational outcomes and support for self and learner needs.”

The report also cautions, “With the current increasing demand for health care services, missteps in GME policies could have long-lasting, detrimental effects on the physician workforce, cost, healthcare quality, access to medical services, and the patient experience.”


Tannaz Rasouli
Sr. Director, Public Policy & Strategic Outreach
Telephone: 202-828-0525


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