Budgetary pressures and plans to restructure the Medicare program may soon lead to changes in GME support. These changes may include reductions in funding for GME if training sources share in program cutbacks. Many policymakers have agreed that GME is a national asset, the quality of which is the foundation for overall health care quality. Educational quality depends on having adequately supported teachers and teaching facilities. Like all education, GME depends on consistent, stable support and having time to adapt to change. Changes made to rationalize the system, to eliminate incentives that distort public policy, and to level support variances should also recognize legitimate differences in local conditions and allow for transitions. Abrupt changes or substantial shifts in funding can have negative effects and disrupt programs.

GME payments vary greatly across institutions. Because substantial changes in payment are possible during corrections, special caution should be exercised to protect individual trainees and teaching institutions. Furthermore, given the length of medical training, longer and more gradual transitions may be warranted than were used to implement Medicare's DRG payment method, the prospective payment system (PPS), for example. In the final analysis, change that comes in response to markets, technologies, or educational practices is preferable to change that is imposed.



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