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On top of that, perspectives differ on changing GME funding. The federal gov- ernment is in favor of substantial reduc- tions. The Council on Graduate Medical Education has recommended current levels of GME funding be preserved and 3,000 new GME positions be established to meet rural and urban underserved communities and to satisfy unmet needs in primary care, surgery, and psychiatry. The Association of American Medi- cal Colleges recommends an additional 15,000 positions with no limitations. Al- though there is general agreement GME financing is too dependent on Medicare as the major payer, the medical educa- tion community has presented no cohe- sive message for how to expand financial support for GME.
A TMA Group Discount Program Member 1.800.667.9723
The time has come to reengineer GME funding. The current hospital- based GME financing mechanism doesn’t reflect our population’s diverse needs. The educational community recognizes the need to shift more physician training into ambulatory settings and facilities where the majority of their practice will take place. This implies resident physi- cians should no longer be primarily em- ployed by teaching hospitals, with their education largely confined to in-patient service duties in a tertiary center. The Accreditation Council for Gradu- ate Medical Education resident educa- tion sponsoring institutions should have unrestricted flexibility to rotate trainees into alternative settings, where they might later choose to practice. Hospital- based educational experiences remain important, but changes in GME funding must reflect the reality of an evolving health care system. To make this happen is going to require a thoughtful effort on the part of all stakeholders involved in medical education. n
American Congress of Obstetricians and Gynecologists President John C. Jennings, MD, of League City, is chair of the Texas Medicine Editorial Board.
54 TEXAS MEDICINE September 2014
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