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A first step is making sure the Accreditation Council for Graduate Medical Education best serves the needs of the public, the training programs and the trainees. This review should facilitate decisions on the number of residency positions that are needed, what training sites should be used and what funding mechanisms are needed to support training.
While it might be desirable to increase the public investment in GME, growth in Medicare funds used to support residency training activities is out the question.
In fact, Medicare already has effectively frozen spending on GME since 1997 by capping the number of residency slots it would fund. This spending freeze has contributed to a shortage of physicians. A further reduction will only worsen the shortage and leave many Americans, including the growing number of elderly who are living with multiple chronic conditions, without the care they need.
We agree that the GME enterprise needs to be reformed. This same group will soon be releasing specific recommendations for changes in the site, content and duration of GME.
Rather than reducing the dollars we now spend, let’s work together to make sure we spend what we have to make the system for training the next generation of physicians more accountable and responsive to the public.
George Thibault, M.D., is president of the Josiah Macy Jr. Foundation, which supports medical and health professional education.