Featured Research

from universities, journals, and other organizations

Transforming physician workforce with competitive graduate education funding

Date:
November 11, 2013
Source:
Dartmouth-Hitchcock Medical Center
Summary:
Graduate Medical Education has fallen short in training physicians to meet changes in the US population and health care delivery systems. But a new proposed funding mechanism coupled to a competitive peer-review process may be the best way to reform the process, according to an analysis.

Graduate Medical Education (GME) has fallen short in training physicians to meet changes in the U.S. population and health care delivery systems. But a new proposed funding mechanism coupled to a competitive peer-review process may be the best way to reform the process, according to an analysis and commentary in the November issue of Health Affairs.

Dr. David Goodman, professor at The Dartmouth Institute for Health Policy & Clinical Practice, and Dr. Russell G. Robertson, dean of the Chicago Medical School, note in their analysis that resistance to change is a long-standing problem in Graduate Medical Education. "The current system is remarkably inflexible -- a place where good ideas for improving the physician workforce go to perish," they said.

Graduate Medical Education is the three-to-eleven-year period of physician training that follows medical school, commonly known as a residency or fellowship training.The number of training positions and the content of the graduate education determine the number, specialty mix, and competencies of physicians entering the workforce, for example cardiologists, pediatricians, radiologists.

"Progress by teaching hospitals, accreditation organizations, and Congress has been too slow to meet the workforce challenges of our changing and aging population and our health care delivery system," the authors said. "If teaching program performance is not linked to funding, recommendations to reform GME will likely remain in a state of inertia."

GME is primarily paid for with more than $13 billion in public money, with the bulk of it coming from Medicare through complex funding formulas. And, the funding mechanism is tied primarily to hospital-based services, ignoring the growing need for competencies that extend beyond acute patient care to improving clinical systems, team-based care, and longitudinal management of patients in the community.

Another deficiency in the funding mechanism is the "inflexible GME pipeline" that is anchored to the number of residents funded at the time of the passage of the Balanced Budget Act of 1997.Some expansion has occurred but mainly in subspecialties, ignoring the need for additional primary care physicians.

To improve the physician workforce, the authors recommend a new system of funding that is responsive to workforce needs, rewards innovation, and uses explicit outcome objectives to evaluate training programs. The funding would be publicly guided and awarded through competitive funding, similar to the process of awarding National Institute of Health peer-reviewed research grants.

"For the physician workforce to change and improve, there must be a trusted public entity that regularly sets overall goals for training direction and pipeline size," the authors said.The entity should be a federal advisory committee composed of the public, public health experts, health care systems, payers and medical educators.

These goals would guide the development of annual requests for funding proposals. Residency programs would be required to apply and compete for GME funding once every 10 years. This means that each year 10 percent of the nation's training programs would be reviewed. New programs would compete for funding. Existing programs that score poorly would receive reduced funding, while meritorious programs could grow. Awards would be for 10 years to enable teaching organization stability.

Applications would be reviewed through study sections. Programs would also need to report performance measures that include educational capacity, processes and outcomes. These measures would be available to the public including fourth year medical students who are choosing residency programs.

Funding would no longer be linked to residents' time caring for Medicare beneficiaries in acute care settings. "Indirect GME funding would no longer reward the very inefficiencies that health care reform is intended to remedy," the authors said.

This new funding mechanism would be an opportunity to transform the health care workforce by incentivizing innovation and a physician specialty mix that responds to the health care needs of the U.S. population. It would also provide financial and educational stability to graduate programs by instituting changes incrementally.


Story Source:

The above story is based on materials provided by Dartmouth-Hitchcock Medical Center. Note: Materials may be edited for content and length.


Journal Reference:

  1. D. C. Goodman, R. G. Robertson. Accelerating Physician Workforce Transformation Through Competitive Graduate Medical Education Funding. Health Affairs, 2013; 32 (11): 1887 DOI: 10.1377/hlthaff.2013.0451

Cite This Page:

Dartmouth-Hitchcock Medical Center. "Transforming physician workforce with competitive graduate education funding." ScienceDaily. ScienceDaily, 11 November 2013. <www.sciencedaily.com/releases/2013/11/131111131445.htm>.
Dartmouth-Hitchcock Medical Center. (2013, November 11). Transforming physician workforce with competitive graduate education funding. ScienceDaily. Retrieved September 23, 2014 from www.sciencedaily.com/releases/2013/11/131111131445.htm
Dartmouth-Hitchcock Medical Center. "Transforming physician workforce with competitive graduate education funding." ScienceDaily. www.sciencedaily.com/releases/2013/11/131111131445.htm (accessed September 23, 2014).

Share This



More Health & Medicine News

Tuesday, September 23, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Liberia Pleads for Help to Fight Ebola

Liberia Pleads for Help to Fight Ebola

AP (Sep. 22, 2014) Liberia's finance minister is urging the international community to quickly follow through on pledges of cash to battle Ebola. Bodies are piling up in the capital Monrovia as the nation awaits more help. (Sept. 22) Video provided by AP
Powered by NewsLook.com
Ebola Doctor Says Border Controls Critical

Ebola Doctor Says Border Controls Critical

AP (Sep. 22, 2014) A Florida doctor who helped fight the expanding Ebola outbreak in West Africa says the disease can be stopped, but only if nations quickly step up their response and make border control a priority. (Sept. 22) Video provided by AP
Powered by NewsLook.com
Global Ebola Aid Increasing But Critics Say It's Late

Global Ebola Aid Increasing But Critics Say It's Late

Newsy (Sep. 21, 2014) More than 100 tons of medical supplies were sent to West Africa on Saturday, but aid workers say the global response is still sluggish. Video provided by Newsy
Powered by NewsLook.com
Sierra Leone in Lockdown to Control Ebola

Sierra Leone in Lockdown to Control Ebola

AP (Sep. 21, 2014) Sierra Leone residents remained in lockdown on Saturday as part of a massive effort to confine millions of people to their homes in a bid to stem the biggest Ebola outbreak in history. (Sept. 20) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins