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 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.
So, where is the American Medical Association and the American Academy of Pediatrics?"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."
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.