Following the release of an Institute of Medicine (IOM) report that proposes sweeping changes in how graduate medical education (GME) is funded, teaching hospital leaders worry about the proposal's implications, Hospitals & Health Networks Daily reports.
The changes proposed by the report include transitioning to a performance based-system, combining GME and indirect medical education into a single fund, and a transformation fund to incentivize innovative GME programs. "In the current system there's not a lot of direct outcome measures that are linked to the money that flows toward graduate medical education, and so this is an attempt to improve upon that," Dave Asprey, Ph.D, an IOM committee member and physician assistant educator, told FierceHealthcare.
But some of these measures will adversely affect patient care and teaching hospitals' training capabilities, Richard Silver, M.D., chief academic officer and chairman of the department of obstetrics and gynecology services at NorthShore University HealthSystem, Evanston, Illinois, told H&HN.
"Whether overt or under the guise of better training for doctors, you are talking about significant reductions in funding," he said, according to the article.
For example, one of the report's recommendations is shifting funding to organizations that fund medical residencies rather than directly to teaching hospitals, arguing that hospitals lack incentive to train residents for non-hospital settings. Although Silver acknowledges teaching hospitals' difficulties on that front, he cites the example of NorthShore, an integrated system that has leveraged resources to provide residents with ambulatory experience. Inter-institutional partnerships, such as NorthShore's arrangement with the University of Chicago for family medicine, can expand this training further, he said.
The American Hospital Association (AHA) expressed similar concerns. "Today's report on graduate medical education is the wrong prescription for training tomorrow's physicians," AHA senior vice president for public policy analysis and development Linda Fishman said in a statement. "We are especially disappointed that the report proposes phasing out the current Medicare GME funding provided to hospitals and offering it to other entities that do not treat Medicare patients."