Graduate Medical Education in a nutshell…
No, a coconut shell
Samantha Easterly
Chapter National Representative
Despite the plethora of resources that our country offers, I am among many who are baffled by the gloomy statistics that reflect the quality of American healthcare. However, my vendetta is to focus on the more productive and positive attributes of what is there to work with. Consider this Still Point article as a report on the current policies and amendments that our government is working on to alleviate some of the issues.
First, what is Graduate Medical Education (GME) funding, in a nut shell? Well, this concept may need something bigger, like a coconut shell. GME funding comes mostly from federal support. Since the late 1990’s, there have been a series of policies put in place to bolster the GME, which provides funding for residency programs. Amendments were made to increase the number of residents and physicians in rural communities. In 2010, the Patient Protection and Affordable Care Act was passed in order to increase the funding for primary care clinics.
So with all of these efforts to increase funding, where has the money gone? There still seems to be limited places for graduating medical students to attend residency. In addition, doctors are still having to deny Medicare and Medicaid patients, because the funding has not kept up with economic inflation. Even so, congress remains loyal to GME funding; for example, this last spring congress voted in favor of making GME a single accreditation system for osteopathic and medical doctor residency programs. Since a majority of osteopathic students become primary care physicians, the funding indirectly supports the efforts bolster a workforce that is desperately needed in America. Ultimately, how are the policies and amendments going to be passed fast enough to keep up with economic inflation or the rising tide of aging patients?
In a thorough article, written by Betty Chung, DO, MPH called, “The state of graduate medical education funding and meeting our nation’s healthcare needs”, Dr. Chung discusses GME and the Institute of Medicine’s synopsis of where GME policy should go in the next ten years. The IOM made one recommendation that the pay-per-service billing model that teaching clinics and hospitals use for Medicare and Medicaid patients should be phased out by a performance-based payment system. Dr. Chung made supporting and opposing comments. It may be difficult for the performance-based payment model to keep up with inflation and properly pay physicians for treating Medicare and Medicaid patients, especially during the transition period. In addition, patient satisfaction may not be an important factor in health outcome. A 2012 Dartmouth study titled, “The cost of satisfaction”, found out that patients who received more procedures, which may not have been deemed necessary, reported higher ‘satisfaction’ with the healthcare that they recieved; however, the ‘satisfied’ population also had higher mortality rates! As per Dr. Chung’s suggestion, instead of phasing out GME, the funding should continue to support a larger residency population and student loan payback opportunities. The IOM’s recommendation may not address the issue of quality or access to health care if the GME was shifted to a performance-based model.
However imperfect the amendments to healthcare policy may be, these changes bring hope. A prospect for more change. As a future primary care physician, I can keep this ball rolling as long as I stay proactive with healthcare policy. Who better to amend the system than the students and practitioners themselves?
It is important for healthcare providers, students, and patients to stay savvy on the current issues that healthcare is working on. If you are a medical student, physician, or patient, I urge you to check out the AOA’s advocacy page and the AMA’s advocacy page for more information on how to stay up-to-date. ❉
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