Texas was one of the biggest losers in the federal government's August 2011 redistribution of unused graduate medical education (GME) positions eligible for Medicare GME funding, a TMA analysis found. The state lost 50.08 direct graduate medical education (DGME) slots and 39.8 indirect medical education (IME) positions from 21 hospitals.
According to the Association of American Medical Colleges, the 10 states with the largest net DGME decreases are New York, California, Texas, Tennessee, Georgia, Massachusetts, Illinois, Missouri, Connecticut, and New Jersey. The largest net IME decreases were in New York, California, Ohio, Texas, Tennessee, Georgia, Illinois, Missouri, and New Jersey, plus Puerto Rico.
The Affordable Care Act requires the Centers for Medicare & Medicaid Services (CMS) to reduce unused residency slots by 65 percent and redistribute them according to certain criteria. This legislation specified that 70 percent of the unused slots must be redistributed to hospitals in states with physician resident-to-population ratios in the lowest quartile. These are Montana, Idaho, Alaska, Wyoming, South Dakota, Nevada, North Dakota, Mississippi, Indiana, Florida, Georgia, and Arizona, plus Puerto Rico. The remainder was redistributed to hospitals in rural areas and to hospitals in the 10 states with the highest proportion of their populations living in federally designated health professional shortage areas. Based on these criteria, Texas was not eligible for any redistributed slots.
Five years ago, the national Council on Graduate Medical Education (COGME), the advisory body to Congress and the federal government on physician training, recommended a minimum 15-percent increase in GME training positions in the United States. The committee determined this growth is needed to better align GME with future health care needs. National professional associations such as the Association of American Medical Colleges, the American Association of Colleges of Osteopathic Medicine, and the American Medical Association also have expressed support for GME expansion. TMA policy supports GME expansion, and TMA has advocated for this in the Texas Legislature over the past decade.
In a commentary in the December 2011 issue of Academic Medicine, "Meeting Future Medical Care Needs: A Perfect Storm on the Horizon," Michael Whitcomb, MD, raises questions about the capacity of hospitals to add sufficient numbers of entry-level physician training positions to meet future workforce needs. Dr. Whitcomb, editor-in-chief of Academic Medicine from 2002 to 2007, notes that existing residency programs are close or equal to the capacity the Accreditation Council for Graduate Medical Education approved. Further, there are considerable challenges for nonteaching hospitals to add GME programs. These include funding requirements to start and maintain new GME programs, and concerns about the availability of staff with the knowledge and experience to establish and oversee programs to comply with accreditation standards.
Instead of bolstering federal and state financial incentives for establishing new GME programs, federal and state governmental policies diminished funding. Teaching hospitals that received Medicare GME funding in 1996 are under a funding freeze that caps funded positions at the numbers in place at that time. Last year, the Texas Legislature took away 28 percent of the money available to medical schools through GME formula funding and 79 percent of the funding appropriated for primary care residency programs in the state budget for 2012-13.
The TMA Council on Legislation and Council on Medical Education are working to identify opportunities for educating state legislators before the 2013 legislative session about the need to grow GME and the important role of state government in facilitating this process. TMA is planning a legislative forum this year to educate legislators about the critical role of GME in meeting the state's physician workforce needs. Look for future articles on the planned forum in Action.
Action, Feb. 15, 2012