Family Physician Academic Community Takes Steps to Protect GME Funding

The AAFP and the Council of Academic Family Medicine (CAFM) are joining forces in calling on Congress to spare graduate medical education (GME) funding from reductions that could result from the ongoing deficit-reduction negotiations.

In a Nov. 28 letter (4-page PDF; About PDFs) to House and Senate leaders, both the AAFP and CAFM urge Congress to not cut GME funding. However, if Congress decides it has to reduce funding for GME, it should target reductions to programs that lead to second certification and protect residency programs that lead to initial certification.

"This would fund the basic training of all physicians," says the letter, signed by the AAFP and the members of CAFM, which include the Society of Teachers of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group and the Association of Departments of Family Medicine. "It would continue to meet the needs of the public good that GME has supported -- the production of physicians to care for the nation's elderly and the nation as a whole."

At the same time, the letter stresses that any reductions in Medicare GME "should be tailored in a manner that would allow for the advancement of primary care training."

In a report (66-page PDF; About PDFs) released two years ago, the Council on Graduate Medical Education said, "there is compelling evidence that health care outcomes and costs in the United States are strongly linked to the availability of primary care physicians. For each incremental primary care physician, there are 1.44 fewer deaths per 10,000 persons. Patients with a regular primary care physician have lower overall health care costs than those without one."

The current Medicare GME system is "outmoded," says the letter from the AAFP and CAFM. And any changes should support the health care system. This means producing more primary care physicians who are well trained in new and emerging models of care and who are able to work in teams and support practices grounded in evidence-based medicine.

The AAFP and the other organizations also a cite a letter the Accreditation Council for Graduate Medical Education (ACGME) sent to its member organizations that warns about the effect of abrupt and severe cuts on GME primary care physician training.

"Sponsorship of residency and fellowship programs accredited by the ACGME is concentrated in 681 health-care-related institutions across the United States," the ACGME letter says. "Well over 300 of these institutions sponsor only one residency program, predominantly primary care programs in small, often rural, locations. … While GME complements this primary care mission, many of these single-program institutions would be forced to sacrifice their GME programs if they lose financial viability. Such reductions in the training pipeline would further threaten the already inadequate long-term supply of primary care physicians in rural America and other medically underserved locations."

The AAFP and the other organizations also urge lawmakers to appropriate funding for the National Health Care Workforce Commission, a body established by the Patient Protection and Affordable Care Act to advise policymakers on a broad range of workforce-related topics, including the ongoing shortage of primary care physicians.

"Without an explicit appropriation, the commission has not been able to do the necessary work of eliminating obstacles that may create and exacerbate workforce shortages and promoting improved coordination on the federal, state and local levels," the letter states.

As a result, lawmakers may enact policies that greatly affect the nation's workforce capacity without the benefit of the commission's expertise.