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Graduate Medical Education That Meets the Nation's Health Needs (2014)

Chapter: Appendix B: U.S. Senate Letters

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Suggested Citation:"Appendix B: U.S. Senate Letters." Institute of Medicine. 2014. Graduate Medical Education That Meets the Nation's Health Needs. Washington, DC: The National Academies Press. doi: 10.17226/18754.
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Suggested Citation:"Appendix B: U.S. Senate Letters." Institute of Medicine. 2014. Graduate Medical Education That Meets the Nation's Health Needs. Washington, DC: The National Academies Press. doi: 10.17226/18754.
×

United States Senate

WASHINGTON, DC 20510

December 21, 2011

Harvey Fineberg, MD, PhD
President
Institute of Medicine
500 Fifth Street, NW
Washington, DC 20001

Dear Dr. Fineberg:

We are writing to encourage the Institute of Medicine (IOM) to conduct an independent review of the governance and financing of our system of graduate medical education (GME). The IOM’s influential 2001 report Crossing the Quality Chasm: A New Health System for the 21st Century recommended a summit to discuss reforming health professions education, which was held in 2002 and attended by 150 important organizations. Earlier, the IOM had convened a public hearing in 1997 to solicit views on GME from various stakeholders, including physician, nursing, hospital and medical college professional associations.

Much has happened since these events. We believe our GME system is under increasing stress, and the projections for our health care workforce are of significant concern. There is growing concern that the United States is failing to adequately match medical training with our medical needs on a national level. Changes to GME are being discussed by Congress, the Medicare Payment Advisory Commission, Accreditation Council for Graduate Medical Education, and various foundations, such as the Josiah Jr. Macy Foundation. It is time to redesign health care workforce education and training in a manner that improves access to and delivery of health care services and enables the future generation of health care professionals to actively participate in creating high quality, lower cost health care.

Specifically, we are interested in an analysis of the governance and financing of GME and potential GME reforms. Some areas deserving of particular attention are: accreditation; reimbursement policy; using GME to better predict and assure adequate workforce supply by type of provider, specialty, and demographic mix; distribution of physicians; the role of GME in the current care of the underserved; the impact of changes in GME on access to health care; and use of GME to assure a future workforce possessing the skill set to effectively address current and future health care needs. In addition, we are particularly interested in IOM’s observations about the uneven distribution of GME funding across states based on need and capacity, and how to address this inequity.

We urge the IOM to move forward immediately with additional public and private sponsors to empanel a consensus committee to develop recommendations to meet the challenges

Suggested Citation:"Appendix B: U.S. Senate Letters." Institute of Medicine. 2014. Graduate Medical Education That Meets the Nation's Health Needs. Washington, DC: The National Academies Press. doi: 10.17226/18754.
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facing GME. We would hope 10 have recommendations from the IOM regarding suggested statutory, regulatory and accreditation changes by the third quarter of 2012. Thank you for your attention to this matter.

Sincerely.

image
Suggested Citation:"Appendix B: U.S. Senate Letters." Institute of Medicine. 2014. Graduate Medical Education That Meets the Nation's Health Needs. Washington, DC: The National Academies Press. doi: 10.17226/18754.
×

United States Senate

WASHINGTON, DC 20510

June 20, 2012

Dear Dr. Fineberg:

As the Institute of Medicine (IOM) prepares for its study of graduate medical education (GME) and the U.S. health workforce, we write to urge you to examine all of the federal programs that help educate and train our health care workforce.

Last year you heard from some of our Senate colleagues explaining that our GME system is under increasing stress and expressing concern that the policy discussion of GME is not always grounded in facts and data. That is why we welcome the IOM’s study – GME is too important to our nation’s health system to change without a comprehensive examination.

As the IOM investigates options that better align GME and physician and other health provider supply with the nation’s future health care needs, we strongly urge you to review a broad range of health workforce education and training programs, not just those funded through Medicare. Indeed, MedPAC in its June 2010 Report to Congress said, “Federal programs other than Medicare could also contribute to improving the output of the GME system as well as to the development of other important health professionals.”

For example, the Health Resources and Services Administration (HRSA) has a number of programs designed to develop the health care workforce and promote access to primary care, including: Children’s Graduate Medical Education (CHGME) program, Titles VII Health Professions programs, Title VIII Nursing Education programs, the new Teaching Health Center (THC) Program. In the same vein, we ask that the IOM review the current definition of Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas (MUAs) and determine if those designations could be more comprehensive or assist in questions of workforce distribution.

Second, we ask that the IOM conduct a comprehensive examination of how GME relates to ultimate physician practice location and physician mal-distribution. We believe that it is important to look beyond the number of training positions in each state to understand and address the factors influencing a physician’s practice location. A recent analysis of physician workforce data appears to indicate that, in fact, the distribution of GME positions across the nation may actually have little or no impact on the geographic distribution of physicians. Medicaid reimbursement levels, employment opportunities for spouses and cost of living may be driving a physician’s decision about where to practice.

Suggested Citation:"Appendix B: U.S. Senate Letters." Institute of Medicine. 2014. Graduate Medical Education That Meets the Nation's Health Needs. Washington, DC: The National Academies Press. doi: 10.17226/18754.
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In addition, over the years, we have all supported efforts to increase the number of GME medical residency slots. We hope that the IOM will also examine the statutory cap on these slots.

Finally, we believe it is also critical to examine the impact of Medicaid GME funding reductions in recent years on health care workforce education and training.

Thank you for your consideration of this request.

Sincerely,

image
Suggested Citation:"Appendix B: U.S. Senate Letters." Institute of Medicine. 2014. Graduate Medical Education That Meets the Nation's Health Needs. Washington, DC: The National Academies Press. doi: 10.17226/18754.
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Suggested Citation:"Appendix B: U.S. Senate Letters." Institute of Medicine. 2014. Graduate Medical Education That Meets the Nation's Health Needs. Washington, DC: The National Academies Press. doi: 10.17226/18754.
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Suggested Citation:"Appendix B: U.S. Senate Letters." Institute of Medicine. 2014. Graduate Medical Education That Meets the Nation's Health Needs. Washington, DC: The National Academies Press. doi: 10.17226/18754.
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Suggested Citation:"Appendix B: U.S. Senate Letters." Institute of Medicine. 2014. Graduate Medical Education That Meets the Nation's Health Needs. Washington, DC: The National Academies Press. doi: 10.17226/18754.
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Suggested Citation:"Appendix B: U.S. Senate Letters." Institute of Medicine. 2014. Graduate Medical Education That Meets the Nation's Health Needs. Washington, DC: The National Academies Press. doi: 10.17226/18754.
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Suggested Citation:"Appendix B: U.S. Senate Letters." Institute of Medicine. 2014. Graduate Medical Education That Meets the Nation's Health Needs. Washington, DC: The National Academies Press. doi: 10.17226/18754.
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Suggested Citation:"Appendix B: U.S. Senate Letters." Institute of Medicine. 2014. Graduate Medical Education That Meets the Nation's Health Needs. Washington, DC: The National Academies Press. doi: 10.17226/18754.
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Today's physician education system produces trained doctors with strong scientific underpinnings in biological and physical sciences as well as supervised practical experience in delivering care. Significant financial public support underlies the graduate-level training of the nation's physicians. Two federal programs--Medicare and Medicaid--distribute billions each year to support teaching hospitals and other training sites that provide graduate medical education.

Graduate Medical Education That Meets the Nation's Health Needs is an independent review of the goals, governance, and financing of the graduate medical education system. This report focuses on the extent to which the current system supports or creates barriers to producing a physician workforce ready to provide high-quality, patient-centered, and affordable health care and identifies opportunities to maximize the leverage of federal funding toward these goals. Graduate Medical Education examines the residency pipeline, geographic distribution of generalist and specialist clinicians, types of training sites, and roles of teaching and academic health centers.

The recommendations of Graduate Medical Education will contribute to the production of a better prepared physician workforce, innovative graduate medical education programs, transparency and accountability in programs, and stronger planning and oversight of the use of public funds to support training. Teaching hospitals, funders, policy makers, institutions, and health care organizations will use this report as a resource to assess and improve the graduate medical education system in the United States.

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