Graduate Medical Education That Meets the Nation's Health Needs (2014) / Chapter Skim
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1 Introduction
1 Introduction
Pages 17-34
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The federal government began funding residency training -- graduate medical education (GME) -- when it enacted the GI Bill through the Servicemen's Readjustment Act of 1944 (Ludmerer, 2012)
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committees have been assembled to assess the GME system and to propose policies to facilitate its improvement (AAMC, 2012a; AMA Citizens Commission on Graduate Medical Education, 1966; Bipartisan Policy Center Health Project, 2013a; Coggeshall, 1965; COGME, 2007, 2010, 2013; Commonwealth Fund Commission on a High Performance Health System, 2006; IOM, 1989, 2003a,b, 2004, 2010; Ludmerer, 2012; Macy Study Group on Graduate Medical Education, 1980; MedPAC, 2010; Weinstein, 2011)
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The 21-member committee included experts in GME financing; residency training of allopathic and osteopathic physicians; undergraduate medical education; nursing and physician assistant education; management of health care systems; physician training in a variety of settings, including teaching hospitals, large academic medical centers, Veterans Health Administration (VHA) facilities, rural areas, safety net institutions, and teaching health centers; the Medicare and Medicaid programs; health and labor economics; and accreditation, licensure, and other regulation of physician training and practice.
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Continuum of Physician Education The continuum of formal physician education begins with undergraduate medical education in an allopathic or osteopathic medical school (see Figure 1-1)
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SOURCE: AACOM, 2013; AAMC, 2012b; ACGME, 2013; Brotherton and Etzel, 2012; Henderson, 2013; National Center for Health Statistics, 2013; National Resident Matching Program, 2013. called residency training.
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Osteopathic Subspecialist GME Graduates Pipeline Programs • U.S. International Specialist Graduates • International Medical Graduates FIGURE 1-1 Continuum of physician education from undergraduate medical education to clinical practice.
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The committee distinguishes among GME, the educational enterprise, and GME funding, the financing of GME, largely through the Medicare and Medicaid programs. This report uses the term "residency" to refer to the initial period of residency training required for board eligibility and fellowship training that may occur afterward.
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* OB/GYN and psychiatry are considered primary care specialties by the Medicare graduate medical education program when the resident is the primary caregiver and the faculty physician sees the patient only in a consultative role.
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These include the AAMC, Accreditation Council for Graduate Medical Education (ACGME) , American Board of Medical Specialties, American Medical Association, American Osteopathic Association, Commission on Dental Accreditation, Council of Medical Specialty Societies, Council on Osteopathic Postgraduate Training, Council on Podiatric Education, Educational Commission for Foreign Medical Graduates, Residency Review Committees (delegated authority via ACGME)
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Targeting the reduction of per capita costs requires that providers practice cost-effective care with appropriate use of resources and that financial management incorporates accountability and transparency. 6 Although the ACA authorized the creation of a National Health Care Workforce Com mission to assume some of these responsibilities, the funds have not been appropriated for its operations.
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2. Encourage innovation in the structures, locations, and designs of graduate medical education programs, to better achieve Goal #1.
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Many of the reports included recommendations regarding accountability and transparency of GME funding; the sufficiency of the numbers of Medicare-supported residency slots; GME performance outcomes, methods and sources of funding; and the site and content of training, innovation, and research (AAMC, 2012a; ACP, 2011; AMA Citizens Commission on Graduate Medical Education, 1966; Bipartisan Policy Center Health Project, 2013a; Buser and Hahn, 2013; Coggeshall, 1965; COGME, 2005a,b, 2007, 2010, 2013; IOM, 1989, 2003a,b, 2004, 2008, 2010, 2012; Johns, 2010; Kirch, 2012; Macy Study Group, 1980; MedPAC, 2001, 2003, 2009, 2010; Office of Academic Affiliations, Veterans Health Administration, 2009; Shannon et al., 2013; Weinstein, 2011)
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This day-and-a-half event featured a wide range of perspectives, including academic medical centers, current and recent trainees, accreditation and certification organizations, allopathic and osteopathic colleges of medicine, physician specialty organizations, state and regional health workforce organizations, private insurers, teaching hospitals, teaching health centers and other communitybased training sites, workforce and health services and policy research. The event was organized in a series of panels on national and regional workforce planning; determining the sufficiency of the workforce; challenges in developing community-based training; perspectives from current residency trainees; innovations in health care and medical education; ensuring accountability; and understanding the costs and financing of GME.
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Citizens Commission on Graduate Medical Education.
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2013. Twenty-first report: Improving value in graduate medical education.
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2001. Chapter 10 -- Treatment of the initial residency period in Medicare's direct graduate medical education payments.
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Recom mendations for graduate medical education to meet the needs of the public. Proceedings of a conference sponsored by the Josiah Macy Jr.
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medical schools using a new measure of medical school cost of attendance. AAMC Analysis in Brief 12(2)
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