IOM’s Vision of GME Will Not Meet Real-world Patient Needs

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Washington, D.C., July 29, 2014AAMC (Association of American Medical Colleges) President and CEO Darrell G. Kirch, M.D., issued the following statement on the Institute of Medicine’s (IOM) report, Graduate Medical Education That Meets the Nation’s Health Needs.

“We appreciate the IOM committee’s recognition of the need for long-term, stable funding for training physicians as well as its vision of a health care system in which patients’ care is coordinated, comprehensive, and provided by highly competent and caring professionals. Medical schools and teaching hospitals are rapidly changing how and where physicians are trained to achieve those same goals.

We also agree with the IOM committee’s recognition that other factors in the health care system, particularly payment policy, are far more significant levers in achieving that vision. There is no doubt that government support is critical in assuring a robust physician workforce to care for an aging, growing, chronically ill population and would benefit from increased transparency and accountability.

Yet the IOM’s proposal to radically overhaul graduate medical education (GME) and make major cuts to patient care would threaten the world’s best training programs for health professionals and jeopardize patients, particularly those who are the most medically vulnerable. The committee’s proposals assume that in the coming decades, our health care workforce would require no expansion of the highly specialized services or physicians equipped to meet the needs of a growing and aging population, with ever greater need for both primary and specialty health care.

By proposing as much as a 35 percent reduction in payments to teaching hospitals, the IOM’s recommendations will slash funding for vital care and services available almost exclusively at teaching hospitals, including Level 1 trauma centers, pediatric intensive care units, burn centers, and access to clinical trials. In addition to hurting patient care, these cuts will limit critical training settings for future physicians, nurses, and other health professionals. While the current system can and is being improved to train more doctors in non-hospital settings, these immediate cuts will destabilize a system that has produced high-quality doctors and other health professionals for more than 50 years and is widely regarded as the best in the world.

Moreover, the IOM has suggested that Medicare trust fund dollars be siphoned off to care for non-Medicare patients (and create new government bureaucracies) at a time when there is increasing concern about the trust fund’s solvency. These recommendations will only exacerbate access issues for an expanding older patient population that needs both primary and specialty care.

Today, the nation’s medical schools and teaching hospitals are training a workforce to meet the health care needs of the nation. Primary care providers, as well as surgeons, orthopedists, cardiologists, oncologists, and other specialists, will be needed in urban, suburban, and rural communities across the country. While most patients may see doctors only in an office setting, these health professionals must have experience treating a wide range of patients with complex illnesses and injuries no matter where they ultimately practice. Teaching hospitals fund and support the majority of residency training, but more than 90 percent of all residency programs require training in non-hospital settings such as Federally Qualified Community Health Centers, private physician offices, and VA medical centers.

The IOM recommendations to cut doctor training and funding for care of the sickest patients at teaching hospitals could not come at a worse time. The nation faces an estimated shortage of 130,000 physicians by 2025, split nearly evenly between primary and many other specialties that care for older adults and children with special needs. By drastically cutting support to teaching hospitals, the IOM recommendations will worsen these projected shortages as teaching hospitals will be forced to make difficult choices between training more physicians for the future needs of the nation and maintaining life-saving clinical services for their communities.

The AAMC and its member institutions believe that a modest increase in the number of federally supported graduate medical education training slots, as has been proposed in legislation (with bipartisan support from nearly 120 members of Congress), would help alleviate the physician shortage and allow time to develop new models of care that will make better use of all the members of the health care team. We also support legislation creating accountability and transparency measures for GME funding received by teaching hospitals (H.R. 1201, Training Tomorrow’s Doctors Today Act).

The health care system faces a time of unprecedented challenge. While the current system is far from perfect, the IOM’s proposed wholesale dismantling of our nation’s graduate medical education system will have significant negative impact on the future of health care. This is hardly the moment to use economic theory to experiment on a system that is integral to maintaining the health of all Americans.”

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The Association of American Medical Colleges is a not-for-profit association representing all 141 accredited U.S. and 17 accredited Canadian medical schools; nearly 400 major teaching hospitals and health systems, including 51 Department of Veterans Affairs medical centers; and nearly 90 academic and scientific societies. Through these institutions and organizations, the AAMC represents 128,000 faculty members, 83,000 medical students, and 110,000 resident physicians. Additional information about the AAMC and U.S. medical schools and teaching hospitals is available at www.aamc.org/newsroom

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