The way American doctors are trained needs to be overhauled, an expert panel recommended on July 29th, saying the current $15 billion system is failing to produce the medical workforce the nation needs.
“We recognize we are recommending substantial change,” says health economist and former Medicare Administrator Gail Wilensky, co-chairwoman of the nonpartisan Institute of Medicine panel that produced the report. “We think it’s key to justifying the continued use of public funds.”
The federal government provides more than $11 billion a year to support the healthcare training of doctors who have graduated from medical school. Most of that goes to the hospitals that sponsor interns and residents. States contribute nearly $4 billion more annually. Even though the system has operated this way for decades, there is little data on how those funds are spent and how well they contribute to train a medical workforce needed for the 21st century.
Despite a growing public investment in graduate medical education, there are persistent problems: uneven geographic distribution of physicians, too many specialists and not enough primary care providers, and a lack of cultural diversity in the physician workforce.
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The committee proposes a sweeping overhaul of the entire financing program for graduate medical education, with the goal of shifting the program to a performance-based system rather than one that merely funnels money to any facility with an accredited healthcare quality job training program.
The panel also calls for spending the same overall amount from Medicare over the next decade but distributed much differently, with a declining share in teaching programs. An increasing share in a “GME transformation fund” that would finance new ways to provide and pay for training, and to fund training positions in priority disciplines and geographic areas.
The funds would still be distributed through the Medicare program, but a new “GME Policy Council” would be created under the office of the secretary of health and human services to oversee workforce issues and commission research on how well the federal dollars are being spent. The committee recommended that states impose similar requirements for Medicaid training funds. Major teaching hospitals in the Northeast would be most immediately affected, since they account for a disproportionate amount of Medicare medical education funding and number of doctors in training.
All of the changes proposed in the report would have to be made by Congress, because government support for graduate medical education is written into Medicare and other laws. The politics, however, are unclear because the changes would produce winners and losers among programs training interns and residents.
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