Graduate Medical

EducationWhat It Is

Why It MattersPossible Solutions

Greater Phoenix Chamber of Commerce

November 19, 2012

GME Defined

• Physician education is a two-step process:1. Completion of an educational

program at an accredited medical school

2. Completion of postgraduate training at a hospital or other healthcare institution, followed by national exams

• Postgraduate education=GME

Road to Physician Workforce

Undergraduate Degree: 4 years

Medical School:4 years

GME/Residency: 3 to 7 years

GME Basics

• Doctors in GME are called residents or fellows

• 9000 GME programs in 26 specialties (e.g., Internal Medicine, Family Medicine, General Surgery, Pediatrics, OB/GYN, etc.)

• All 50 states and US territories require GME for physicians to become licensed to practice

• 110,000 resident physicians in the US

Why GME Matters

Access to medical care depends on a sufficient physician workforceA robust physician workforce contributes to a community’s economic developmentPhysicians often choose to practice where they train

Who Funds GME

Primary Sources of Federal Funding:

• Medicare – $9.5 billion to teaching hospitals capped at

100,000 positions in 1997– $3 billion: direct payments to cover resident

stipends, expenses– $6.5 billion: indirect medical education

adjustment; added costs in patient care associated with training

• Veteran Affairs & Department of Defense (12,000 residents)

• HRSA – Children’s GME

Who Funds GME

Other Funding:• Medicaid (State $$ plus

FMAP)– 2005: 47 states provided $3.78

billion – 2009: 41 states provided $3.18

billion – 9 additional states considering

ending payments

• Private (hospital supported)

GME Medicaid Funding in Arizona

Year Funding Number of Hospitals

2006 $22 million 13

2007 $33 million 16

2008 $68 million 15

2009 $81 million 15

2010 $86 million 5

2011 $113 million 6

• 2007 legislation authorizes IGTs; money begins flowing in 2008• 2008 hospitals begin receiving funds for indirect costs• 2010 GF support eliminated; all GME funding coming through IGTs

Trends and Transformation:Factors Impacting GME and

the Physician Workforce

• Physician shortage• Specialization• Healthcare delivery transformation• State and federal budget

pressures

National Physician Shortage*

*AAMC, 2010

Arizona’s Physician Pipeline

Arizona U.S.Physicians per 100,000

220 259

Residents per 100,000

22 36

Medical Students per 100,000

30 31

Arizona must add 850 residency positions to bring up to national level of 36 per 100,000 persons

Other Considerations: Specialization

• Increasingly, physicians are electing to practice in subspecialties

• 2001: subspecialties accounted for 49% of total residency programs and 13% of residents

• 2011: subspecialties accounted for 55% of total residency programs and 17% of residents

Delivery System Transformation

Professional Silos

Clinical Integration

Coordinated Care

Budget Pressures & Funding Hole

• 1997 Medicare cap• 2010 elimination of state general

fund support for Medicaid GME • Current federal deficit discussions:

proposal to cut Medicare IME

Hospita

l fun

ds

and IG

Ts

Options for State Moving Forward

• GME Funding Estimates:– $50 million TF to support current

residencies– $140 million TF to support

residency expansion (850 slots)• Funding Options• Development of an academic

medical center/system in Phoenix

Questions?