From the Editor: Align GME with medical needs
1. Fate of loan deferment program in your hands
2. IOM: Health care workforce not ready for boomer explosion
3. Latest chapters in workforce debate: Wrong doctors in the wrong places?
4. General surgery, some subspecialties suffering workforce woes
5. Medical education in the news
6. Reader feedback: “Preventative” medicine disrespected
7. Reader feedback II: Reentry to physician workforce problematic
8. Take part in The Next Generation of physicians
9. Nominate an outstanding program director or DIO for ACGME award
10. A modest proposal: Zero duty hours, zero patient errors
11. Virtual Mentor: System constraints on optimal care
12. Attend the AMA Section on Medical Schools June meeting
Dear colleague,
Where do uninsured patients find medical help? Some go to nearby hospital emergency departments, but many turn to physicians. In her article, “The Unsustainable US Health Care System: A Blueprint for Change," Dr. Jennifer DeVoe uses clinical vignettes to show how doctors strive to find medical care for their under- and uninsured patients. She then calls for rebuilding the health care system, and redirecting spending toward patient-centered medical homes.
Similarly, two reports just published by the Council on Graduate Medical Education (COGME) call for reinvigorating GME training to better prepare physicians for the future.
- New Paradigms for Physician Training for Improving Access to Health Care (18th Report) recommends new and expanded models of training, enlargement of federal loan programs, incentives for clinical practice in underserved areas, establishment of a national medical school, and increased physician training in areas of limited medical access.
- Enhancing Flexibility in Graduate Medical Education (19th report) recommends 15 percent more funded GME positions, innovative training models, broader training venues, fewer regulatory barriers, and making the public's health the driving force for GME.
Aligning GME training to population health and disease prevention is not a new idea. If our health system is to achieve universal coverage and access, we will need the right mix of physicians in the appropriate settings and it would be wise to start training physicians in such settings now.
As always, we welcome your comments on this or other
issues at gme@ama-assn.org
Paul H. Rockey, MD, MPH, Director
AMA Division of Graduate Medical Education
1. Fate of loan deferment program in your hands
The AMA and its Resident and Fellow Section is working for a permanent fix to the proposed elimination of the 20/220 pathway, which allows deferral of education loan repayment for up to 3 years during training (Resident and Staff Physician, April).
Program directors and physicians in training: Please help! Let your Congressional members know that you support the 20/220 pathway.
Call your Congressional representative using the AMA call-in script (PDF, 21KB).
Use the Capwiz site to send your representative a message.
Check out the AMA-RFS site for more background information.
2. IOM: Health care workforce not ready for boomer explosion
The nation’s health care workforce is “too small and woefully unprepared” to provide care for the growing ranks of the elderly, according to a new Institute of Medicine report.
The report, Retooling for an Aging America: Building the Health Care Workforce, calls for expanded education and training in the basics of geriatric care for all health professionals as well as increased reimbursements from Medicare, Medicaid, and other health plans to boost recruitment and retention of geriatric specialists
The AMA also noted that proposed Medicare physician payment cuts would further jeopardize care for seniors.
The IOM report garnered significant media coverage. AMNews (May 5) noted that the number of geriatricians in the US (about 7,100) represents a 22 percent decline from 2000.
An article in Reuters noted that the IOM report recommends resident physician training take place “in all settings where the elderly receive care, including nursing homes and assisted-living facilities.”
3. Latest chapters in workforce debate: Wrong doctors in the wrong places?
Simply producing more physicians is not the answer to the nation’s health care needs, write David C. Goodman, MD, and Elliott S. Fisher, MD, MPH, in the April 17 New England Journal of Medicine (“Physician Workforce Crisis? Wrong Diagnosis, Wrong Prescription”).
Aside from the costs, “unfettered growth is likely to exacerbate regional inequities in supply and spending,” they write, and “unrestricted expansion of graduate medical education . . . would probably further undermine primary care and reinforce trends toward a fragmented, specialist-oriented health care system.”
The same issue of the Journal contains a report of the recent history of the physician workforce debate and expansion and notes that “the actions taken to educate more medical undergraduates are based on state and local decisions with virtually no direct federal involvement or support.”
An article in the April 16 Wall Street Journal Health Blog reviews the work of Drs. Goodman and Fisher and asks, “What if the problem isn’t a lack of doctors but a lack of the right kind of doctors in the right places?”
One of those places that is lacking is rural South Dakota, where many shrinking small towns no longer have enough patients to support a physician practice. (Yankton, SD, Daily Press & Dakotan, April 3).
In Iowa, a new report (PDF, 2MB) from the state medical society developed 40 recommendations to guide physicians and state lawmakers on four key issues: physician workforce, medical education and training, care for the uninsured, and the public health system.
In Minnesota, a local television station in Minneapolis featured a news story on workforce concerns and resident physicians, including the low pay, high debt, and long hours for recent medical school graduates (KARE 11 TV).
People in Massachusetts are discovering that access to universal health care coverage is one thing, but access to and availability of a primary care physician is another (New York Times, April 5).
To help make primary care more attractive, the Medicare Payment Advisory Commission (MedPAC) has recommended that primary care physicians receive higher payment rates (AMNews, May 5).
4. General surgery, some subspecialties suffering workforce woes
Primary care isn’t the only field suffering from reduced interest among medical students. A study in the April Archives of Surgery (abstract) finds that the supply of general surgeons in the US declined by more than 25 percent over the last two decades.
Potential solutions to the decline, according to the study’s authors, include increased funding of residency positions and addressing the lifestyle and salary issues that have made general surgery less attractive as a career choice.
The study was covered in an April 22 article in the Orlando Sentinel.
Other fields seeing a decline in interest include subspecialties that are less lucrative than others. A May 5 Wall Street Journal article describes a dearth of physicians in neuro-opthalmology, endocrinology, rheumatology, and pulmonology.
Comments on the article are posted on the Journal’s Health Blog.
5. Medical education in the news
Working through the AMA Resident and Fellow Section, one resident took action that led the ACGME to eliminate waiting periods for health insurance coverage and benefits for new residents (Surgical Rounds, March).
Rising medical school debt loads may be one factor in the decreasing popularity of careers in medical research and primary care, both of which offer compensation at the lower end of the scale (AAMC Reporter, January).
A “cultural revolution” in how residents and young physicians balance their careers and their desire for “controllable lifestyle” is changing how medicine is practiced (The Wall Street Journal, April 29).
(Blog, including physician comments)
First-year medical school enrollment is projected to grow 21 percent over a 10-year period ending in 2012, according to a new AAMC survey, and nine new medical schools are under development or discussion, according to the LCME. (Inside Higher Ed, May 2).
Lake Erie College of Osteopathic Medicine in Erie, PA, plans to open a branch campus in fall 2009 at Seton Hill University in Greensburg, with 100 students per class (Pittsburgh Tribune-Review, April 30).
The April 5 issue of the BMJ features a debate on the workforce implications of increasing numbers of women physicians and asks, "Are there too many female medical graduates?"
Medicine vs history: In Greenwich Village, large-scale plans for new facilities at St. Vincent’s Hospital Manhattan have aroused the ire of advocates for architectural preservation (New York Times, April 1).
An AAMC task force has recommended that drug and medical device companies “be banned from offering free food, gifts, travel, and ghost-writing services to doctors, staff, and students” in all medical schools and teaching hospitals (New York Times, April 28).
In a recent AMA eVoice column, AMA President Ronald M. Davis, MD, urged physicians to make their practices “green” and ecologically sustainable, and suggested that environmental awareness be part of the medical education curriculum (HealthLeaders Media, April 30).
6. Reader feedback: “Preventative” medicine disrespected
In our April issue we referenced a March 19 New York Times article on career choices of recent MD graduates in which a medical student said, “The No. 1 thing that is going to save your life is the humdrum preventative stuff like blood pressure and cholesterol. But there is not a lot of respect for doctors who do that because anyone can get into it.”
In response, we received an e-mail from Sharon Hull, MD, MPH, highlighting the “lack of respect” accorded preventive medicine. A lack of federal funding for residency programs is one factor in the decline in the number of programs, just when the nation needs more physicians with these competencies, not fewer.
7. Reader feedback II: Reentry to physician workforce problematic
Having read many articles about physician shortages nationwide and globally, Rosalyn Carson-DeWitt, MD, finds it ironic that “there are no viable reentry paths for physicians who graduate from medical school, take a hiatus from medicine, and then wish to return.”
The Council on Medical Education has drafted a report on this topic, for discussion at the June meeting of the AMA House of Delegates. In addition, the American Academy of Pediatrics has developed the Physician Reentry into the Workforce Project.
8. Take part in The Next Generation of physicians
The Next Generation is a monthly online publication that presents interesting and relevant information to over 10,000 premedical students, medical students, and general interest readers.
Produced by Harvard undergraduate students in collaboration with the New England Journal of Medicine, The Next Generation has published such articles as:
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An interview with the medical advisor for “Scrubs”
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Physicians' tips on living a sane life
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First-hand experiences from gross anatomy
The May issue features four articles:
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An in-depth look at anesthesiology
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A report on medical oncology through an interview with a leader in the field
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A discussion of the current challenges of TB research
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A description of the MD/MPH combined degree and its merits
Want to reach over 10,000 readers each month? Submissions are sought from readers for article ideas and whole articles. E-mail Allen Cheng.
9. Nominate an outstanding program director or DIO for ACGME award
The Accreditation Council for Graduate Medical Education (ACGME) is now accepting nominations of program directors for the 2009 Parker J. Palmer Courage to Teach Award and nominations of designated institutional officials for the 2009 Courage to Lead Award.
Nominations are due July 2 and must include the application, curriculum vitae, and three letters of reference. Application forms are available on the ACGME Web site.
10. A modest proposal: Zero duty hours, zero patient errors
“I predict that if studies based on 60- and 70-hour work weeks fail to eliminate clinical errors or markedly decrease patient mortality rates (a likely result), the next recommended studies will involve decreasing the work week to 50 and then 40 hours. Someday, we may reach the apex of care, reducing clinical errors and patient mortality rates to zero by restricting trainees from providing any medical care and instead giving them complete freedom to learn from books and the Internet, at home, on their own timetables.”
- Bernard M. Jaffe, MD, writing in the March issue of Surgical Rounds
In related news, a rise in program citations for work-hour violations reflects improved consistency in tracking violations, not an increase in the number of incidents, notes the ACGME (AMNews, April 21).
11. Virtual Mentor: System constraints on optimal care
Health care systems operate at many levels and take many forms: From hospital risk management policies and insurance company coverage determinations to Medicaid and Medicare reimbursement rules, the medical malpractice system, and federal regulation of physician business practices.
The May issue of Virtual Mentor looks at how these systems—essential to the delivery of health care in the 21st century—affect the day-to-day practice of medicine and how physicians manage the unintended consequences of systems that sometimes constrain good patient care.
12. Attend the AMA Section on Medical Schools June meeting
The AMA Section on Medical Schools (AMA-SMS) is meeting June 13-14 at the Hyatt Regency Chicago, in conjunction with the AMA House of Delegates.
Take advantage of this opportunity to network, help develop AMA policy, and discuss issues affecting medical education. Learn more about the AMA-SMS and register for the meeting free of charge (hurry, deadline is May 12) by calling (312) 464-4655.
Educational sessions at the meeting include:
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USMLE comprehensive review recommendations and the implications for licensure
Friday, June 13, 1:00 – 2:00 p.m.
Featured speakers: Peter Scoles, MD, National Board of Medical Examiners, and James Thompson, MD, Federation of State Medical Boards
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The state of medical school faculty: challenges and solutions
Friday, June 13, 3:00 - 4:30 p.m.
Key speaker: Darrell Kirch, MD, Association of American Medical Colleges
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Teaching teamwork and its impact on patient care
Saturday, June 14, 10:45 a.m. - noon
This panel presentation will highlight an evidence-based teamwork system. Moderator: Robert McQuillan, MD, Creighton University School of Medicine
Panelists: Robert Munier, MD, Agency for Healthcare Research and Quality, and Karen Frush, MD, Duke University School of Medicine
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Current issues impacting medical education
Saturday, June 14, 1:00 - 2:30 p.m.
This session will include mini-presentations on innovations in faculty development, competencies in geriatric medicine for medical students, and advancing the use of performance measures in medical education.
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About us ...
The GME e-Letter is produced by the Medical Education Group of the American Medical Association (AMA), publishers of the Graduate Medical Education Directory ("Green Book") and other medical education products.
Our monthly e-mail communication covers information of interest to the graduate medical education community. Readers include program directors and staff at ACGME-accredited and board-approved residency and fellowship programs, designated institution officials (DIOs), hospital administrators, professional associations, medical school deans, and governmental organizations.
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Medical Education Products
American Medical Association
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