Friday, July 8, 2011

GME Funding for Family Medicine Residencies Must Be Preserved.. Now!

In a letter from the ACGME to the American Board of Medical Specialties, American Hospital Association, American Medical Association, Association of American Medical Colleges, and Council of Medical Specialty Societies, the ACGME warns of consequences that could occur due to proposed cuts in Medicare Graduate Medical Education (GME) funding. GME funding is the main source of financial stability for residency programs that train this country's medical interns and residents - the pipeline of production for physicians.

These cuts would threaten:
  • The availability of residency positions to produce new physicians
  • Access to care for the Medicare population
  • Access to care for the underserved, underinsured, and uninsured
  • Community-based primary care residency programs which produce primary care physicians that typically serve in rural and other underserved areas
  • The distribution of primary care residency slots in multi-specialty institutions towards more lucrative sub-specialty training which reimburse the institution more for procedural rather than preventive care
  • Residency training in general with the possibility of support from industry (insurance companies, pharma, etc) and/or implementation of tuition for residency training
  • Entering clinical practice after one year of internship to repay student debt resulting in the undereducation of practicing physicians
The Association of American Medical Colleges provides a variety of resources explaining the importance of GME funding, including their advocacy to increase the amount of funding for GME in order to prevent/slow down a shortage of physicians. This includes a letter to President Obama sent on 5 July 2011 urging the President to preserve GME funding.

The American Association of Colleges of Osteopathic Medicine took it a step further by initiating a member-driven action alert. This alert allows members and non-members to submit emails and letters to their representatives in an effort to generate more than the usual auto-generated email response from our elected officials.  The AACOM also submitted a joint letter with the American Osteopathic Association to Congress opposing cuts to GME.

The American Academy of Family Physicians focus in on primary care, asking its members to take action on its Speak Out Grassroots Advocacy site by contacting legislators to specifically preserve primary care.
"The deficit reduction conversations continue. Lawmakers are re-thinking Medicare’s Graduate Medical Education (GME), and at this critical time, they should be reminded of primary care’s importance. Our representatives have an opportunity to change this program so that it encourages the innovations in primary care training that will help build a workforce our communities can count on."
So, where is the American Medical Association and the American Academy of Pediatrics?

Currently on the homepage of the AMA, they are worrying about the Independent Payment Advisory Board (IPAB) as well as a decrease in Medicare payments for diagnostic imaging.   It seems like CMS is starting to do the work that the RUC should be doing to decrease overvalued services?  Apparently this is more important than worrying about cuts to GME.  The AAP does not seem to be worrying about much of anything.  The ACP has submitted a letter to the President and Congress urging for a debt ceiling agreement which addresses GME, but nothing really focused on GME.

The AOA had no problem leading the way as one of the first medical organizations to take action.  The ACP continues its support for primary care, though it is easy to tell they do so very cautiously to keep its medicine sub-specialty members content.  Will the AMA step up at the sake of losing support from its specialty members to help save funding for primary care?  Or will they issue a blanket statement asking to preserve GME funding in general while still knowing that the preservation of GME funding does not necessarily mean the preservation of primary care training.  It may mean the shifting of more training towards specialties that get paid more for procedures...  who funds the RUC again?  Who makes money off of coding books with codes for procedures for which the RUC makes recommendations to CMS for reimbursement rates?  I digress...

Any cuts to GME that do not preserve funding specifically for primary care could be catastrophic, especially for programs that can barely get by with the current level of funding.  GME cuts that do not preserve or increase primary care residency funding will continue the current shift in our physician workforce that favors specialization and does not value primary care.  It is at times like these when I am most thankful for choosing a family medicine residency in the military - a health care system that actually appreciates and values primary care as its foundation for health care delivery.


  1. You know I must contest to your skepticisim of the AMA's efforts in this issue. First and foremost, I direct you to policy D-305.967 The Preservation, Stability and Expansion of Full Funding for Graduate Medical Education. Which the house of delegates has passed and re-passed multiple times over the past decade, including this most recent meeting. I would then encourage you to look at this article discussing the AMA's efforts as part of its Center for Transforming Medical Education ( and specifically recommend downloading the pdf at the end. Could they be more visible about this one issue that is extremely important to us. Yes. Are they concerned with a multitude of other problems that concern the practice of medicine, something we know very little about just yet. Yes. In the end, you have to bear in mind that the AAFP is a primary care organization, but the AMA is not.

  2. I posted AMA's efforts (and AAFP's recognition) of their advocacy and policy to support funding for programs outside of academic and hospital networks on the #SaveGME stream.

    When GME funding cuts are front and center/on the table, AMA should be leading the way in public defense efforts with the specialty organizations by their side. Unfortunately, this is not the case.