Navigation Links
Transforming the physician workforce through competitive graduate education funding
Date:11/11/2013

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 funding mechanism is the "inflexible GME pipeline" that is anchored to the number of residents funded at the time of the passage of the Balanced Budget Act of 1997. Some expansion has occurred but mainly in subspecialties, ignoring the need for additional primary care physicians.

To improve the physician workforce, the authors recommend a new system of funding that is responsive to workforce needs, rewards innovation, and uses explicit outcome objectives to evaluate training programs. The funding would be publicly guided and awarded through competitive funding, similar to the process of awarding National Institute of Health peer-reviewed research grants.

"For the physician workforce to change and improve, there must be a trusted public entity that regularly sets overall goals for training direction and pipeline size," the authors said. The entity should be a federal advisory committee composed of the public, public health experts, health care systems, payers and medical educators.

These goals would guide the development of annual requests for funding proposals. Residency programs would be required to apply and compete for GME funding once every 10 years. This means that each year 10 percent of the nation's training programs would be reviewed. New programs would compete for funding. Existing programs that score poorly would receive reduced funding, while meritorious programs could grow. Awards would be for 10 years to enable teaching organization stability.

Applications would be reviewed through study sections. Programs would also need to report performance measures that include educational capacity, processes and outcomes. These measures would be available to the public including fourth year medical students who are choosing residency programs.

Funding would no longer be linked to residents' time caring for Medicare beneficiaries in acute care settings. "Indirect GME funding would no longer reward the very inefficiencies that health care reform is intended to remedy," the authors said.

This new funding mechanism would be an opportunity to transform the health care workforce by incentivizing innovation and a physician specialty mix that responds to the health care needs of the U.S. population. It would also provide financial and educational stability to graduate programs by instituting changes incrementally.


'/>"/>

Contact: Annmarie Christensen
annmarie.christensen@dartmouth.edu
603-653-0897
Dartmouth-Hitchcock Medical Center
Source:Eurekalert

Related medicine news :

1. Trivedi Masters Invite People across the Globe for the Historic Event, 'TRANSFORMING HUMANITY'
2. New Logo Better Communicates Niche of Scott Sheldon, LLC: Transforming Supply Chains
3. Colorado Takes a Huge Step toward Transforming the Family Dining Experience
4. Scott Sheldon Unveils New Web Design: Transforming Supply Chains
5. Transforming America by redirecting wasted health care dollars
6. Innovaacom Announces November Launch of New Hospital-Based Physician Training Program
7. Online course improves physicians skill level for detecting skin cancer
8. Health Care Without Harm and Physicians for Social Responsibility Report: One-Quarter of CA Hospitals Are Committed to Sustainable Food as Center of Healing Mission
9. Endocrinologist Dr. Reema Patel Joins Raritan Bay Physicians’ Group, PC
10. Physician shortage could be cut by new primary care models, study finds
11. Electronic and Internet health tools may decrease in-person physician visits
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/17/2017)... ... 17, 2017 , ... For the first time, International Scholarship ... exhibit floor for the 2017 HIMSS Conference & Exhibition at the ... more than 40,000 healthcare industry professionals are expected at the conference, where they ...
(Date:2/17/2017)... ... February 17, 2017 , ... Empowering ... Francis' goals for each and every seminar, session and class she offers. ... five different brainwave tools which help energize creativity, focus mental functions, enhance athletic ...
(Date:2/17/2017)... ... February 17, 2017 , ... Qualis ... a finalist in the 8th Annual DecisionHealth Platinum Awards in recognition of its ... Health’s work is recognized across multiple award categories, highlighting four of the organization’s ...
(Date:2/17/2017)... ... 2017 , ... Program will serve more than 5,000 kids ... Soccer Foundation announced today that they have awarded nine grants to expand the ... soccer mentoring program, teaches kids the fundamentals of soccer while striving to help ...
(Date:2/17/2017)... ... February 17, 2017 , ... ... and focusing on all facets of clinical trial planning and management. Pharmica discussed ... engagement, and more. In addition, attendees stopping by Pharmica’s booth were able to ...
Breaking Medicine News(10 mins):
(Date:2/17/2017)... LOUIS , Feb. 17, 2017   FormFast ... has announced a new partnership with Engage , ... the United States . FormFast will serve as ... of Engage,s implementations with MEDITECH .  ... provides essential functionality to complement and enhance the electronic ...
(Date:2/17/2017)... February 17, 2017 On Thursday, ... 500 edged lower at the closing bell, while the ... the 20,000 benchmark. Moreover, five out of nine sectors ... consideration yesterday,s market sentiment, Stock-Callers.com assessed the following Medical ... PLC (NYSE: SNN ), ABIOMED Inc. (NASDAQ: ...
(Date:2/16/2017)... DUBLIN , Feb. 16, 2017 ... "Global Markets for Emerging Medical Device Technologies" report to ... ... heart valves, open procedures, general instruments, non-drug coated implantables, large ... have been in use over the last two to three ...
Breaking Medicine Technology: