Special Feature

States work to expand GME

During the past decade, in response to an aging and growing U.S. population, medical schools have increased their MD and DO graduates by 20 percent. However, entry-level GY1 residency positions have increased by only 10 percent, and physicians completing core residency training programs (leading to initial board certification) increased by less than 5 percent. Meanwhile, Medicare funding for GME is capped, cuts to indirect medical education (IME) funding have been proposed, and several states have withdrawn Medicaid GME funding.

Against this challenging backdrop, several states and regions are seeking creative solutions to expand GME programs to meet their growing physician workforce needs. GME leaders nationwide shared some of these innovations at the November 4 meeting of the AMA Section on Medical Schools in Denver.

In the northwest U.S., the WWAMI program has helped rural Washington, Wyoming, Alaska, Montana and Idaho create more access to public medical education and avoid redundancy and increased costs. Building on nearly four decades of community-based education, the WWAMI region recently created new GME programs in psychiatry and internal medicine and continues to expose Seattle-based residents at the University of Washington to WWAMI rotations.

Two different states, in opposite corners of the country, are working to innovate and surmount their respective GME challenges. In Florida, awareness is growing that GME slots need to expand. Through recent development of new in-state medical schools, MD and DO graduates now exceed GME entry-level positions in Florida, and the gap is projected to grow to 500 by 2020. Meanwhile, in Oregon, the schools of medicine, dentistry, nursing and pharmacy at Oregon Health and Science University are working together to educate students interprofessionally and leverage the health care workforce to optimally meet Oregon's needs.

In Colorado, two foundations (spun off when several not-for-profit hospitals converted to for-profit) continue to fund primary care GME programs. Also, a recent private/public partnership created the Colorado Health Service Corps—a student loan repayment program administered by the Colorado Department of Health that places physicians in underserved urban and rural areas.

Meanwhile, Vermont, which is pursuing a "single-payer" insurance model, is challenged to preserve GME funding and enhance physician retention under this new model of medical care financing. Currently, the state is above average in medical students and residents but lags in physician retention for its population.

Finally, in Northwest Ohio, which faces unique socio-economic challenges, the business community has embraced GME and academic medical center expansion as essential components of economic revitalization for the region. Among other successes, this has led to a growth in resident positions from 167 to 284 over ten years.