Internists recommend ways to better align graduate medical education financing with workforce needs

The Alliance for Academic Internal Medicine (AAIM) and the American College of Physicians (ACP) call for changes that better align funding for Graduate Medical Education (GME) with the nation's health care workforce needs. The paper, Financing U.S. Graduate Medical Education, is published in Annals of Internal Medicine.

GME is the process by which graduated medical students progress to become competent practitioners in a particular field of medicine. GME programs, referred to as residencies and fellowships, allow trainees to develop the knowledge, skills, and attitudes required for independent practice. GME plays a major role in addressing the nation's workforce needs, as GME is the ultimate determinant of the output of physicians.

Under the current system, GME is funded through a combination of sources. The federal government, which is the largest source of GME financing, provides GME funding to teaching hospitals through Medicare. States fund GME through Medicaid, but the level of funding varies greatly by state. Private payers pay higher rates to teaching hospitals compared with other hospitals to fund GME, though they do not explicitly contribute to GME. And finally, GME receives funding from private sources, such as hospitals, universities, and gifts or grants from industry, though the amount can vary significantly.

According to authors from the AAIM and ACP, the current system of GME financing does not consider physician workforce needs on the local, regional, or national level. They recommend changes to better align GME with the nation's health care workforce needs. These recommendations include using Medicare GME funds to meet policy goals to ensure an adequate supply, specialty mix, and site of training; spreading the costs of financing GME across the health care system; evaluating the true cost of training a resident and establishing a single per resident amount; increasing transparency and innovation; and ensuring that primary care residents receive training in well-functioning ambulatory settings that are financially supported for their training roles.