LEBANON, NH Graduate Medical Education (GME) has fallen short in training physicians to meet changes in the U.S. population and health care delivery systems. But a new proposed funding mechanism coupled to a competitive peer-review process may be the best way to reform the process, according to an analysis and commentary in the November issue of Health Affairs.
Dr. David Goodman, professor at The Dartmouth Institute for Health Policy & Clinical Practice, and Dr. Russell G. Robertson, dean of the Chicago Medical School, note in their analysis that resistance to change is a long-standing problem in Graduate Medical Education. "The current system is remarkably inflexible a place where good ideas for improving the physician workforce go to perish," they said.
Graduate Medical Education is the three-to-eleven-year period of physician training that follows medical school, commonly known as a residency or fellowship training. The number of training positions and the content of the graduate education determine the number, specialty mix, and competencies of physicians entering the workforce, for example cardiologists, pediatricians, radiologists.
"Progress by teaching hospitals, accreditation organizations, and Congress has been too slow to meet the workforce challenges of our changing and aging population and our health care delivery system," the authors said. "If teaching program performance is not linked to funding, recommendations to reform GME will likely remain in a state of inertia."
GME is primarily paid for with more than $13 billion in public money, with the bulk of it coming from Medicare through complex funding formulas. And, the funding mechanism is tied primarily to hospital-based services, ignoring the growing need for competencies that extend beyond acute patient care to improving clinical systems, team-based care, and longitudinal management of patients in the community.
Another deficiency in the f
|Contact: Annmarie Christensen|
Dartmouth-Hitchcock Medical Center