IOM Wants Big Change in Doc Training
Written by Editor   
Wednesday, August 06, 2014 08:10 AM

An expert panel recommended Tuesday completely overhauling the way government pays for the training of doctors, saying the current $15 billion system is failing to produce the medical workforce the nation needs.  

The federal government, mostly via the Medicare program, currently provides more than $11 billion per year in payments to support the training of doctors who have graduated medical school. Most of that goes to the hospitals that sponsor interns and residents. States, through the Medicaid program, contribute nearly another $4 billion annually.  "The scale of government support for this phase of physician education is unlike that given to any other profession in the nation," said the report.

But there is little data on how those funds are spent and how well they contribute to the preparation of a medical workforce needed.  Not only that, the authors note, "a variety of surveys indicate that recently trained physicians in some specialties cannot perform simple procedures often required in office-based practice and lack sufficient training and experience in care coordination, team-based care, and quality improvement."

All of the changes proposed in the report would have to be made by Congress, because government support for graduate medical education is written into Medicare and other laws.  

The committee proposes a sweeping overhaul of the entire financing program for graduate medical education, with the goal of shifting the program "to a performance-based system," rather than one that merely funnels money to any facility with an accredited training program.

The current Medicare medical education payment system would be phased out over 10 years. At the end of the phase-out, policymakers would reassess whether Medicare should continue to subsidize doctor training at all, and, if so, to what extent.

It's time to close the open checkbook for teaching hospitals, the panel said. "The statutes governing Medicare's GME financing were developed at a time when hospitals were the central -- if not exclusive -- site for physician training," the report said. But by doing that, "the Medicare payment system discourages physician training outside the hospital, in clinical settings where most healthcare is delivered."

Source:  http://www.medpagetoday.com/PublicHealthPolicy/MedicalEducation/46986

The American Academy of Family Physicians welcomed the proposal "to shift funding away from the legacy hospital-based system to more community-based training sites; including allowing funding to go directly to those organizations that sponsor residency training," AAFP President Reid Blackwelder said in a statement. "By giving these organizations more control over how they train residents, the financial investment will better align with the health needs of a community."

But the broader-based doctor group, the American Medical Association, reacted negatively, saying: "Despite the fact that workforce experts predict a shortage of more than 45,000 primary care and 46,000 specialty physicians in the U.S. by 2020, the report provides no clear solution to increasing the overall number of graduate medical education positions to ensure there are enough physicians to meet actual workforce needs."  That's because the panel didn't agree with studies projecting a shortage of physicians.  Rapid changes in medical practice, including sharply higher use of nonphysician health professionals such as physician assistants and nurse practitioners, might be enough to provide care to aging baby boomers and those obtaining coverage under the Affordable Care Act.

Wilensky, who ran Medicare when Congress overhauled the physician payment system in the early 1990s, said the chances for making such changes depend very much on lawmakers from states that currently get less funding -- which is most of them.

Given the fact that a disproportionate amount of current funding goes to institutions "in New York, New Jersey, and Massachusetts," Wilensky said she's surprised "that everyone else has tolerated this peculiar distribution of funds" for so long.

Source:  http://www.medpagetoday.com/PublicHealthPolicy/MedicalEducation/47027