Graduate Medical Education

Residency funding targeted for cuts; contact Congress

Tell your members of Congress today that the Jan. 1 cut to graduate medical education (GME) funding must be averted.

Without congressional action, the 2 percent sequester cuts to Medicare will adversely affect GME funding. This funding reduction would compromise access to care for patients and further limit the number of residency positions for an ever-growing number of medical students.

According to estimates, the United States will experience a shortage of more than 90,000 physicians by 2020. That number is expected to surpass 130,000 by 2025.

It only takes a moment to urge your elected officials to preserve current levels of GME funding. Send an email through the AMA Physicians Grassroots Network today.

To learn more about the AMA's work with Congress this legislative session, including efforts to protect GME funding, read a recent blog post by AMA President Jeremy A. Lazarus, MD.

Quotable: Three views on funding for GME

Three recent articles look at graduate medical education and ways to link funding of GME to public goods, such as improved quality of care, increased numbers of primary care physicians and medical education in community and outpatient settings.

Maybe the way we pay for graduate medical education – from the time a student graduates from medical school to the time they go into professional practice – could address not only the important work of teaching hospitals, which often have a breadth of specialties, expensive but vital equipment, and a spectrum of the sickest patients, but also the ways in which health care is changing. Lots more health care is taking place in outpatient settings. And community health centers are becoming an ever more important lifeline for people who can't afford care elsewhere.
- From "Primary care and graduate medical education funding: a new model?"

Behind every challenge lies an opportunity. In order to effectively reduce readmissions, a redesign in how we promote the development of and payment for education in the ambulatory care setting is overdue. Why not create new policy payments – outpatient medical education payments – that are supported with these unspent dollars? Why not promote unique clinical services and the training of health professionals in alternative sites to provide team education in hospice, community health centers, home- and community-based care? Thoughtful policies could emphasize and reward training and education in ambulatory care and ultimately result in more effective, comprehensive care.
From "Impact of New Payment Methodologies on Support for Graduate Medical Education"

No mechanisms exist to hold residency programs accountable for their GME spending, so Medicare and Medicaid have no way to influence how the funding is used. Tracking performance measures and outcomes for each program, such as the number of graduates who enter undersupplied specialties and practice in rural settings, is a good first step toward ensuring the maximum public benefit.
From "The critical state of graduate medical education funding"

As Congress works through its "lame duck" session and the "fiscal cliff" negotiations, the AMA is focusing efforts to preserve graduate medical education funding. Like Medicare physician payments, this funding faces a 2 percent cut under the Budget Control Act of 2011. Proposals for additional substantive cuts also have been placed on the table as lawmakers search for ways to reduce spending. With a predicted physician shortage on the horizon, any cuts to already limited funding would be a great disservice to the nation's patients. Visit the AMA Legislative Action Center to write to your members of Congress about this important issue.

Duty-hour rules fallout: Resident satisfaction drops

It's been nearly a decade since the Accreditation Council for Graduate Medical Education (ACGME) first instituted duty-hour regulations for resident/fellow physicians. Despite years of study, researchers remain unsure of how duty hour rules have affected patient care, resident training and resident quality of life.

A recent study in the Annals of Surgery looked at 216 orthopedic residents in training between 2003 and 2009. Respondents believed that the sufficiency of direct clinical experience, the number of hours spent performing major procedures, and their overall satisfaction with their educational experience had declined. Also, even though mean work hours decreased from 74.5 to 66.2 between 2003 and 2009, the average reported hours of sleep remained unchanged.

"This really challenges one of the primary assumptions about duty-hour standards — that if you let obviously tired residents go home earlier more often, that they would sleep more. But they're not sleeping more," said Debra Weinstein, MD, senior study author and vice president for graduate medical education with Partners Healthcare in Boston, in coverage of the study in American Medical News.

Real skills, virtual brains: Neurosurgery simulator gains converts

Residents and attending physicians at the Mount Sinai School of Medicine are using NeuroTouch, a simulator that is thought to be the nation's first virtual reality brain surgery simulator.

The simulator provides visual, touch and sound feedback to make the experience as real as possible, allowing physicians to hone their skills on a high level but in the safety of a simulator.

Advocates for the new technology say it can improve patient safety and reduce medical liability risks, reports American Medical News.

Meanwhile, newly minted physicians at one Chicago medical school can help avoid the "July effect" through a simulation-based "mastery learning" training camp.

News and notes

• The Accreditation Council for Graduate Medical Education (ACGME) has approved new subspecialty and program requirements for the field of Emergency Medical Services.
• HCA hospitals to add hundreds of medical residencies in Tampa Bay (Tampa Bay Times).
• Medical genetics groups seek to boost sparse supply of students and graduates (Genetic Engineering & Biotechnology News).
• Accreditation groups for allopathic, osteopathic residency programs reach landmark agreement (American Medical News).
• Cutting GME funding could lead to negative impacts in primary care training (Wing of Zock).
• A place where patients are thankful for interprofessional team training (Wing of Zock).
• Medical schools and residencies need to better prepare the next generation of physicians to care for the LGBT patient population (American Medical News).
• Provide your feedback on proposed changes to ACGME program requirements as well as those fields entering phase II of the ACGME's Next Accreditation System.
• Redesigned clinic handoffs at Pritzker win innovation challenge (Wing of Zock).

AMA resources for you and your trainees

• View an archive version of our webinar on ways to expand and improve GME.
• Check out our new recommendations on strategies to expand funding of GME.
• Get trend data on undergraduate and graduate medical education.
• Help your residents master the ACGME general competency requirements.
• Learn more about patient safety in medical education.
• Get updated information on medical licensure.
• Obtain state-by-state GME data .
• Get an updated copy of our GME glossary (email meded@ama-assn.org with "glossary" in subject line).

For more reading

• AMA medical education and professional ethics Twitter pages
• American Medical News
• Ending Disparities e-Letter