A four-step approach to expand graduate medical education

It is possible to obtain a consensus on how to expand graduate medical education (GME), according to a new Health Affairs post.

The article, written by a team of authors led by Richard Rieselbach, professor emeritus of medicine, University of Wisconsin School of Medicine and Public Health, Madison, identifies a four-step proposal that they believe can be implemented immediately.

The authors developed the proposal in the wake of controversy over an Institute of Medicine (IOM) report this summer that recommended sweeping changes to how to fund GME. Those changes included a proposal to transition to a performance-based system combining GME and indirect medical education into a single fund, and a transformation fund to provide incentives to innovate GME programs.

Teaching hospital leaders balked at the recommendations, stating that some of the measures would adversely affect their training capabilities and patient care.

Rieselbach and his team said in the article that their four-pronged approach is feasible, as it provides GME expansion where it is most urgently needed, requires a simple reauthorization of a current statute, lacks any immediate incursion on Medicare GME funding or changes in Medicare rules and aligns with the IOM report's recommendations.

The authors suggest:

  1. Congressional reauthorization and funding of the Teaching Health Centers (THC) GME program, administered by the Health Resources and Services Administration.

  2. Additional primary care and other specialty GME expansion using the new Veterans Affairs GME position.

  3. Strategic primary care and other specialty GME expansion based on state workforce needs using Medicaid GME funds.

  4. Expansion of THC based on the outcome of a Center for Medicare and Medicaid Innovation-funded study of modified THC demonstrations associated with Community Health Center (CHC)/Academic Medicine partnerships. The authors believe this GME innovation could help sustain CHCs and improve access to care for Medicaid beneficiaries and other low-income patients while preparing residents for 21st century practice.

"Because implementation of GME expansion will require substantial time and planning, building a consensus among GME stakeholders around a feasible and attainable pathway for GME expansion must be pursued immediately," the authors write. They suggest that the Accreditation Council for Graduate Medical Education organize a forum on expanded GME and use their proposal as a springboard for discussion in order to develop a consensus on a pathway.

To learn more:
- read the article