Journal of General Internal Medicine

, Volume 29, Issue 11, pp 1546–1551 | Cite as

Addressing the Nation’s Physician Workforce Needs: The Society of General Internal Medicine (SGIM) Recommendations on Graduate Medical Education Reform

  • Angela Jackson
  • Robert B. Baron
  • Jeffrey Jaeger
  • Mark Liebow
  • Margaret Plews-Ogan
  • Mark D. Schwartz
  • For the Society of General Internal Medicine Health Policy Committee
Perspective

ABSTRACT

The Graduate Medical Education (GME) system in the United States (US) has garnered worldwide respect, graduating over 25,000 new physicians from over 8,000 residency and fellowship programs annually. GME is the portal of entry to medical practice and licensure in the US, and the pathway through which resident physicians develop the competence to practice independently and further develop their career plans. The number and specialty distribution of available GME positions shapes the overall composition of our national workforce; however, GME is failing to provide appropriate programs that support the delivery of our society’s system of healthcare. This paper, prepared by the Health Policy Education Subcommittee of the Society of General Internal Medicine (SGIM) and unanimously endorsed by SGIM’s Council, outlines a set of recommendations on how to reform the GME system to best prepare a physician workforce that can provide high quality, high value, population-based, and patient-centered health care, aligned with the dynamic needs of our nation’s healthcare delivery system. These recommendations include: accurate workforce needs assessment, broadened GME funding sources, increased transparency of the use of GME dollars, and implementation of incentives to increase the accountability of GME-funded programs for the preparation and specialty selection of their program graduates.

KEY WORDS

healthcare delivery system graduate medical education training workforce 

Notes

Conflict of Interest

The authors and all other contributors declare that they do not have a conflict of interest.

REFERENCES

  1. 1.
    Iglehart J. Financing Graduate Medical Education—Mounting Pressure for Reform. N Engl J Med. 2012;366:1562–3.PubMedCrossRefGoogle Scholar
  2. 2.
    Association of American Medical Colleges. Physician shortages to worsen without increases in residency training. 2010:Available at https://www.aamc.org/download/286592/data/. Accessed September 12, 2013.
  3. 3.
    Schwartz M. Health Reform and the Primary Care Workforce Bottleneck. J Gen Intern Med. 2012;27(4):469–72.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Smith C. Teaching High-Value, Cost-Conscious Care to Residents: The Alliance for Academic Internal Medicine—American College of Physicians Curiculum. Ann Intern Med. 2012;157:284–6.PubMedCrossRefGoogle Scholar
  5. 5.
    National Resident Matching Program (NRMP). Main Residency Match. 2013:http://www.nrmp.org/match-data/main-residency-match-data/. Accessed September 15, 2013.
  6. 6.
    West C, Dupras D. General medicine vs. subspecialty career plans among internal medicine residents. JAMA. 2012;308(21):2241–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Frintner M, Cull W. Pediatric training and career intentions 2003–2009. Pediatrics. 2012;129(3):522–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Biggs W, Schmittling G, Bieck A, Crosley P, Pugno P. Entry of US medical school graduates into family medicine residencies: 2010–2011 and 3-year summary. Fam Med. October 2011;43(9):625–30.Google Scholar
  9. 9.
    Council on Graduate Medical Education (COGME). Twentieth Report to Congress: Advancing Primary Care. 2010:Available at http://www.hrsa.gov/advisorycommittees/bhpradvisory/cogme/Reports/twentiethreport.pdf. Accessed on February 22, 2014.
  10. 10.
    Committee on Ways and Means. U.S. House of Representatives, 89th Congress, 1st Session, House Report, No. 213. Washington, DC; 1965.Google Scholar
  11. 11.
    Rich E, Liebow M, Malathi S, Parish D, Wolliscroft D, Fein O, et al. Medicare Financing of Graduate Medical Education: Intractable Problems, Elusive Solutions. J Gen Intern Med. 2002;17(4):283–92.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Medicare Payment Advisory Commission (MedPAC). Report to the Congress: Aligning incentives in Medicare. Medicare Payment Advisory Commission, Chapter 4. June 2010:Available at http://www.medpac.gov/documents/Jun10_EntireReport.pdf, Accessed Accessed February 22, 2014.
  13. 13.
    Wynn B, Guarino C, Morse L, Cho M. Alternative ways of financing graduate medical education: Report to the Office of the Assistant Secretary for Planning and Evaluation. May 2006:Available at http://aspe.hhs.gov/health/reports/06/AltGradMedicalEdu/report.pdf. Accessed September 15, 2013.
  14. 14.
    Chaudhry S, Khanijo S, Halvorsen A, McDonald F, Patel K. Accountability and transparency in graduate medical education expenditures. Amer J Med. 2012;125:517–22.PubMedCrossRefGoogle Scholar
  15. 15.
    The White House, The National Commission on Fiscal Responsibility and Reform. The Moment of Truth: Report of the National Commission on Fiscal Responsibility and Reform. December 2010:Available at http://www.fiscalcommission.gov/sites/fiscalcommission.gov/files/documents/TheMomentofTruth12_1_2010.pdf, Accessed February 22, 2014.
  16. 16.
    Medicare Payment Advisory Commission (MedPAC). Report to the Congress: Aligning Incentives in Medicare. June 2010:Available at http://medpac.gov/documents/Jun10_EntireReport.pdf. Accessed May 18, 2013.
  17. 17.
    113th Congress 1st Session. Resident Physician Shortage Reduction Act, S 577. March 14, 2013:Available at http://www.gpo.gov/fdsys/pkg/BILLS-113s577is/pdf/BILLS-113s577is.pdf. Accessed September 2, 2013.
  18. 18.
    113th Congress 1st Session. Resident Physician Shortage Reduction Act of 2013, HR 1180. March 14, 2013:Available at http://www.gpo.gov/fdsys/pkg/BILLS-113hr1180ih/pdf/BILLS-113hr1180ih.pdf. Accessed September 2, 2013.
  19. 19.
    113th Congress 1st Session. Training Tomorrow's Doctors Today, HR 1201. March 14, 2013:Available at http://www.gpo.gov/fdsys/pkg/BILLS-113hr1201ih/pdf/BILLS-113hr1201ih.pdf. Accessed September 2, 2013.
  20. 20.
    Association of American Medical Colleges (AAMC). AAMC Physician Workforce Policy Recommendations. September 2012:Available at https://www.aamc.org/download/304026/data/2012aamcworkforcepolicyrecommendations.pdf. Accessed on February 22, 2014.
  21. 21.
    American Medical Association (AMA). AMA Policies for Resident Work Conditions Reform: H-310.917 Securing Funding for Graduate Medical Education. 2013:Available at http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/medical-student-section/advocacy-policy/resident-work-conditions/policies.page. Accessed March 10, 2013.
  22. 22.
    American College of Physicians. Aligning GME Policy with the Nation's Health Care Workforce Needs. 2011:Available at http://www.acponline.org/advocacy/where_we_stand/policy/gme_policy.pdf. Accessed March 10, 2013.
  23. 23.
    Voorhees K, Prado-Gutierrez A, Epperly T, Derksen D. A Proposal for Reform of the Structure and Financing of Primary Care Graduate Medical Education. Fam Med. 2013;45(3):164–70.PubMedGoogle Scholar
  24. 24.
    Council on Graduate Medical Education (COGME). Twenty-First Report. Improving Value in Graduate Medical Education. August 2013:Available at http://www.hrsa.gov/advisorycommittees/bhpradvisory/cogme/Reports/twentyfirstreport.pdf. Accessed February 22, 2014.
  25. 25.
    Institute of Medicine Consensus Study. Governance and Financing of Graduate Medical Education. 2012:Available at http://www.iom.edu/Activities/Workforce/GMEGovFinance.aspx. Accessed September 2, 2013.
  26. 26.
    American College of Physicians Inc. National Health Care Workforce Commission. 2013:Available at http://www.acponline.org/advocacy/where_we_stand/assets/ii4-national-health-care-workforce.pdf. Accessed October 6, 2013.
  27. 27.
    Association of American Medical Colleges. Health Care Groups Request Funding for Workforce Commission. March 2013: Available at https://www.aamc.org/advocacy/washhigh/highlights2013/343388/052413healthcaregroupsrequestfundingforworkforcecommission.html. Accessed August 30, 2013.
  28. 28.
    Nasca T, Philibert I, Brigham T, Flynn T. The Next GME Accreditation System—Rationale and Benefits. N Engl J Med. 2012;366:1051–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Millbank Q. 2005;83:457–502.CrossRefGoogle Scholar
  30. 30.
    Fisher E, Wennberg D, Stukel T, Gottlieb D, Lucas F, Pinder E. The implications of regional variations in Medicare spending. Part 1: The content, quality and accessibility of care. Ann Intern Med. 2003;138(4):273–87.PubMedCrossRefGoogle Scholar
  31. 31.
    Chen C, Petterson S, Phillips R, Mullan F, Bazemore A, O'Donnell S. Towards Graduate Medical Education Accountability: Measuring the Outcomes of GME Institutions. Acad Med. 2013;88:1–14.CrossRefGoogle Scholar
  32. 32.
    Phillips R, Turner B. The Next Phase of Title VII Funding for Training Primary Care Physicians for America's Health Care Needs. Ann Fam Med. 2012;10:163–8.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • Angela Jackson
    • 1
  • Robert B. Baron
    • 2
  • Jeffrey Jaeger
    • 3
  • Mark Liebow
    • 4
  • Margaret Plews-Ogan
    • 5
  • Mark D. Schwartz
    • 6
  • For the Society of General Internal Medicine Health Policy Committee
  1. 1.Section of General Internal Medicine, Department of MedicineBoston University School of MedicineBostonUSA
  2. 2.San Francisco School of Medicine, Division of General Internal Medicine, Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  3. 3.Division of General Internal MedicineThe Raymond and Ruth Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  4. 4.Division of General Internal MedicineMayo Clinic College of MedicineRochesterUSA
  5. 5.Division of General Internal Medicine, Department of MedicineUniversity of VirginiaCharlottesvilleUSA
  6. 6.Department of Population HealthNew York University School of MedicineNew YorkUSA

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