The content and effectiveness of Graduate Medical Education (GME) is an important determinant of the quality and cost of our health care system. Location of GME affects the size and geographic distribution of our physician workforce, thereby influencing access to care.
Given this important relationship and the investment of tax-payer dollars to fund GME, it is essential to resolve the longstanding GME policy controversy which impairs coordination of GME policy with national needs. Efforts to break the GME policy logjam over the past 30 years have faltered in spite of multiple recommendations by the Council on Graduate Medical Education (COGME), which addressed the issues through numerous but with inadequate resources and influence.
The Accreditation Council for Graduate Medical Education (ACGME) effectively assures the quality of training programs. However, other increasing concerns about GME funding and accountability have created enough dissatisfaction and controversy to prompt a Congressional request for an, released in July, 2014 (2). This report proposed major reforms which would create a GME system with greater transparency, accountability and strategic direction that aligns with national needs. Stakeholder response to the IOM Report currently is being by Congress in the Health subcommittee of the House Energy and Commerce (E&C) committee. Their input from various stakeholders has been complex and lacking in consensus, thereby perpetuating the GME policy logjam, creating a daunting challenge and thereby decreasing prospects of any comprehensive legislative GME reform in this session of Congress.
Since the introduction of the “resident physician shortage reduction act of 2009” (S. 973) and its companion bill in the House (H.R. 2251), multiple bills have been introduced to achieve a 15 percent increase in the aggregate number of Medicare-sponsored residents in approved GME programs. The most recent attempt was S. 1148 and H.R. 2124, introduced in April of this year. All of these bills have attempted to lift the cap on Medicare-funded GME positions, ostensibly to support the training of critically needed primary care physicians and non-primary care specialists. However, none have provided any meaningful provisions to ensure that new residency slots are dedicated to primary care specialties. Instead, they include specific distributional criteria which would disproportionally increase Medicare funding for non-primary care specialty training.