Post on 30-Apr-2015
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The Tectonic Plates of GME May Be Moving
Fitzhugh Mullan, MDMurdock Head Professor of Medicine and Health PolicyGeorge Washington University
Number of MD and DO Medical School Graduates from 1970 - 2013
Year
Nu
mb
er o
f G
rad
uat
es
0
5000
10000
15000
20000
25000
MD DO Total
Academic Year MD Graduates DO Graduates Total Graduates
1980-1981 15,632 1,151 16,783
1990-1991 15,427 1,534 16,961
2000-2001 15,796 2,510 18,306
2001-2002 15,676 2,536 18,212
2002-2003 15,531 2,607 18,138
2003-2004 15,829 2,713 18,542
2004-2005 15,760 2,756 18,516
2005-2006 15,927 2,708 18,635
2006-2007 16,140 3,000 19,140
2007-2008 16,168 3,364 19,532
2008-2009 16,467 3,588 20,055
2009-2010 16,836 3,631 20,467
2010-2011 17,362 4,159 21,521
2011-2012 17,343 4,458 21,801
2012-2013 18,156 4,726 22,882
Number of MD and DO Medical School Graduates from 1980 - 2013
Sources: AAMC and ACCOM
1st Year MD and DO Enrollment In2003 Compared With Projected 2017
Enrollment Figures
2003 2017 # and % Increase
MD 16,541 21,434 4,893 29.6% DO 3,308 6,675 3,367 101.8%
_______________________________________________ Combined 19,849 28,109 8,260 41.2%
Sources: AAMC Results of the 2012 Medical School Enrollment Survey, May 2013; AAMC Enrollment Data 2008 https://www.aamc.org/download/60740/data/enrollmentdata2008.pdfAACOM – Trends in Osteopathic Medical School Applicants, Enrollment and Graduates
Graduates and Projected Number of US MD and DO Graduates from 2008-2021
2008-2009
2009-2010
2010-2011
2011-2012
2012-2013
2013-2014*
2014-2015*
2015-2016*
2016-2017*
2017-2018**
2018-2019**
2019-2020**
2020-2021**
0
5000
10000
15000
20000
25000
30000
MD DO Total
Num
ber o
f Gra
du
ates
Year
| Extrapolated | | Projected |
Academic Graduation Year MD Graduates DO Graduates Total Graduates
2008-2009 16,467 3,588 20,055
2009-2010 16,836 3,631 20,467
2010-2011 17,362 4,159 21,521
2011-2012 17,343 4,458 21,801
2012-2013 18,156 4,726 22,882
2013-2014* 18,665 5,428 24,093
2014-2015* 19,230 5,788 25,018
2015-2016* 19,517 5,986 25,503
2016-2017* 20,055 6,449 26,504
2017-2018** 20,654 6271 26,925
2018-2019** 21,053 6,222 27,275
2019-2020** 21,255 6,179 27,434
2020-2021** 21,434 6,675 28,109
MD and DO Medical School Graduation Projections from 2008 - 2021
Sources: AAMC and ACCOM*Notes extrapolated data **Notes projected data
New Entrants into GME: Entrants into GME Without Prior GME 2010-2013
Sources: NCHWA analysis of data from AAMC and AACOM, April 2012; Number for 2011 is provisional; Number for 2013 is from NRMP and AOA
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 201320,000
21,000
22,000
23,000
24,000
25,000
26,000
27,000
28,000
29,000
30,000
25,105 25,15125,384 25,617 25,574
25,959 26,084 26,220
26,69227,198
27,489
28,45028,871
29,292
Entr
ants
Year
Projected US MD and DO Medical School Graduates (with 3% Attrition Rate) and 1st
Year Entrants into GME (2009-2021)
Year2014-2021 data are based on a 1% annual increase in entrants into GME
2009 2010 2011 2012 2013 2014* 2015* 2016* 2017* 2018** 2019** 2020** 2021**15,000
17,000
19,000
21,000
23,000
25,000
27,000
29,000
31,000
33,000
1st Year Entrants into GME US Medical School Graduates with 3% Attrition Rate
Match Year
1st Year Entrants into GME
US MD and DO Medical School
Graduates (3% Attrition Rate)
Difference
2009 27,198 20,055 7,143
2010 27,489 20,467 7,022
2011 28,450 21,521 6,929
2012 28,871 21,801 7,070
2013 29,292 22,882 6,410
2014* 29,585 23,370 6,215
2015* 29,881 24,267 5,613
2016* 30,180 24,738 5,442
2017* 30,481 25,709 4,772
2018** 30,786 26,117 4,669
2019** 31,094 26,457 4,637
2020** 31,405 26,611 4,794
2021** 31,719 27,266 4,453
Projected US MD and DO Medical School Graduates (with 3% Attrition Rate) and 1st Year Entrants into GME (2009-2021)
*Notes extrapolated data **Notes projected data 2014-2021 data are based on a 1% annual increase in entrants into GME
Teaching Health Centers and THCGME
White K. et al, The Ecology of Medical Care, NEJM, 1961
L. Green et al., The Ecology of Medical Care Revisited, NEJM, 2001
• GME History• Teaching in Health Centers• The ACA opportunity• Section 5508 of the ACA established the
Teaching Health Center Graduate Medical Education (THCGME) program
Teaching Health Centers
• The program is funded at $230 million from FY2011 to FY2015, a five year initiative.
• Administered by the Health Resources and Services Administration (HRSA).
• Under the jurisdiction of the Senate Health Education Labor and Pension (HELP) Committee, and the House Energy and Commerce Committee.
THCGME Program
• There are 44 THCs in 21 states across the country.– 3 states (Colorado, Florida and Tennessee) will be
added in the 2014 THC cohort.
• THCs are located in underserved communities in rural and inner city areas.
• Each year new THCs are added to the program. – In 2011 - 11 total THCs – In 2012 - 22 total THCs – In 2013 - 44 total THCs
Current THCs
THC Residency Numbers
2011 2012 2013
Number of THC Programs
11 22 44
PGY-1 THC Residents
44 154 273
# of residents per year in steady state
132 462 819
Specialty Number of THCsDental 2
Family Medicine 29
Internal Medicine 5
OB/GYN 2
Pediatrics 3
Psychiatry 3
THC Residency Specialties
THC Accreditation
THC Year ACGME AOA ACGME/AOA CODA N/A
2011 5 1 4 1 0
2012 0 9 1 1 0
2013 8 11 2 0 1
Total 13 21 7 2 1
• GW was awarded the Evaluation and Initial Assessment of HRSA Teaching Health Centers contract.
• This is a five year contract to better understand this model of community-based residency training, including an examination of the: – costs of training in THCs– contributions to the primary care workforce,
particularly in underserved communities.
THC Evaluation Project
• THC funding will end in 2015. • THC classes that began in July 2013 do not have
funding for the last 9 months of their training.• Future classes will have even less time funded.• THC programs may only be able provide partial
training to residents, and are hesitate to recruit or continue to expand their training programs.
Challenges for Teaching Health Centers
• On November 23, 2013 Senator Bernie Sanders (I-VT) introduced Senate Bill 1759, Teaching Health Center Reauthorization Act, which provides $800 million in funding to reauthorize the THCGME program for an additional five years.
• House staffers are examining a short-term funding patch. This patch will provide approximately $90 million to allow THCs to maintain full funding for all residents in their programs for academic year 2015-2016.
Options to Extend Funding for THCs
• The President’s FY 2015 Budget increases funding for primary care residency positions.
• THCGME program is not specifically sustained within any new targeted support for GME in the FY 2015 Budget.
FY 2015 President’s Budget
THCs are:
• Dedicated primary care education centers
• De-institutionalized medical training
• A means of increasing residency training without
“feeding the monster”
• Transformative and revolutionary: you pick!
Message for the Hill