Graduate Medical
EducationWhat It Is
Why It MattersPossible Solutions
Greater Phoenix Chamber of Commerce
November 19, 2012
GME Defined
• Physician education is a two-step process:1. Completion of an educational
program at an accredited medical school
2. Completion of postgraduate training at a hospital or other healthcare institution, followed by national exams
• Postgraduate education=GME
Road to Physician Workforce
Undergraduate Degree: 4 years
Medical School:4 years
GME/Residency: 3 to 7 years
GME Basics
• Doctors in GME are called residents or fellows
• 9000 GME programs in 26 specialties (e.g., Internal Medicine, Family Medicine, General Surgery, Pediatrics, OB/GYN, etc.)
• All 50 states and US territories require GME for physicians to become licensed to practice
• 110,000 resident physicians in the US
Why GME Matters
Access to medical care depends on a sufficient physician workforceA robust physician workforce contributes to a community’s economic developmentPhysicians often choose to practice where they train
Who Funds GME
Primary Sources of Federal Funding:
• Medicare – $9.5 billion to teaching hospitals capped at
100,000 positions in 1997– $3 billion: direct payments to cover resident
stipends, expenses– $6.5 billion: indirect medical education
adjustment; added costs in patient care associated with training
• Veteran Affairs & Department of Defense (12,000 residents)
• HRSA – Children’s GME
Who Funds GME
Other Funding:• Medicaid (State $$ plus
FMAP)– 2005: 47 states provided $3.78
billion – 2009: 41 states provided $3.18
billion – 9 additional states considering
ending payments• Private (hospital supported)
GME Medicaid Funding in
ArizonaYear Funding Number of
Hospitals2006 $22 million 132007 $33 million 162008 $68 million 152009 $81 million 152010 $86 million 52011 $113 million 6
• 2007 legislation authorizes IGTs; money begins flowing in 2008• 2008 hospitals begin receiving funds for indirect costs• 2010 GF support eliminated; all GME funding coming through IGTs
Trends and Transformation:Factors Impacting GME and
the Physician Workforce• Physician shortage• Specialization• Healthcare delivery transformation• State and federal budget
pressures
National Physician Shortage*
*AAMC, 2010
Arizona’s Physician Pipeline
Arizona U.S.Physicians per 100,000
220 259
Residents per 100,000
22 36
Medical Students per 100,000
30 31
Arizona must add 850 residency positions to bring up to national level of 36 per 100,000 persons
Other Considerations:
Specialization• Increasingly, physicians are
electing to practice in subspecialties
• 2001: subspecialties accounted for 49% of total residency programs and 13% of residents
• 2011: subspecialties accounted for 55% of total residency programs and 17% of residents
Delivery System Transformation
Professional Silos
Clinical Integration
Coordinated Care
Budget Pressures & Funding Hole
• 1997 Medicare cap• 2010 elimination of state general
fund support for Medicaid GME • Current federal deficit discussions:
proposal to cut Medicare IME
Hospita
l fund
s
and IG
Ts
Options for State Moving Forward
• GME Funding Estimates:– $50 million TF to support current
residencies– $140 million TF to support
residency expansion (850 slots)• Funding Options• Development of an academic
medical center/system in Phoenix
Questions?