With a population of roughly 600,000, Washington, D.C., receives about $173 per person in Medicare graduate medical education (GME) payments, while Wyoming receives $2.91 per person, despite a similar population size.
Numbers like this illustrate an imbalance in how Medicare distributes $10 billion a year for GME, according to a recent study by George Washington University.
The study found large differences in states’ numbers of residents funded by Medicare and average GME payments per resident, among other variables. New York state receives nearly 20 percent of all Medicare’s GME funding, while 29 other states each receive less than 1 percent each.
The findings document a “substantial imbalance favoring the Northeast,” according to the study. Massachusetts, Rhode Island, Pennsylvania and Connecticut all receive more than $71 in funding per person in those states, compared to $7.47 in Mississippi and just $1.94 in Montana, which brings up the rear.
The distribution of GME is important because most residents practice near where they train. “Addressing the geographic imbalance in GME support presents a challenge because the current Medicare GME system has no mechanism for reallocating training positions,” the study said.
“Unless the GME payment system is reformed, the skewed payments will continue to promote an imbalance in physician availability across the country,” said Fitzhugh Mullan, MD, professor of medicine and health policy at George Washington University and lead author of the study.
However, an increase of Medicare funding for GME is unlikely as Congress considers proposals that would further limit residency funding, despite the number of residency slots funded by Medicare being capped for more than a decade.
Dr. Mullan noted that one thing is clear: Something has to be done. The study recommended a central coordinating body or institution for the GME system that could deliberate and make policy about public investments into GME.
“Decisions need to be made about priorities and the potential movement of resources from one locale to the other,” the study said. “Formula-driven GME and the blunt reforms that capped individual hospitals at their 1997 training levels have frozen in place a very irregular geography and, effectively, robbed current policymakers of the ability to make strategic judgments about the $10 billion provided annually.”
The AMA’s Save GME campaign calls on Congress to preserve funding for residency training. Visit the campaign website today to tell your lawmakers about the importance of GME for American health care.
