AMA Backs GME Funding for Nonhospital Residency Sites, Other Medical Education Initiatives

Delegates at the 2009 interim meeting of the AMA House of Delegates in Houston recently adopted several recommendations that put the AMA squarely in line with key components of the AAFP's new physician workforce reform policy and with other medical education issues championed by the Academy.

Some of the most important measures adopted concern expanding funding for graduate medical education, or GME; limiting future restrictions on resident and fellow duty hours; and enhancing the availability of clinical training sites for medical students.

AMA delegates adopted, with amendments, a report from the AMA Council on Medical Education on GME funding (see page 39 of 155-page PDF; About PDFs) that recommends the AMA "continue to advocate for funding for training in nonhospital sites and for all training activities required in graduate medical education programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA)."

Another recommendation in the report directs the AMA to "continue to be vigilant while monitoring pending legislation that may change the financing of medical services (health system reform) and advocate for expanded and broad-based funding for graduate medical education (from federal, state and commercial entities)."

The report also recommends that the AMA "continue to advocate for GME funding that reflects the physician workforce needs of the nation."

AAFP delegate Mack Worthington, M.D., of Chattanooga, Tenn., who testified on this issue before the AMA Reference Committee on Professional Standards Advocacy on Nov. 8, said the recommendation pushing for funding for training in nonhospital sites is particularly important for family medicine because much of that training occurs in ambulatory settings.

In recommending adoption of the report, the reference committee noted that many of the federal health care reform proposals now being considered would impact the current funding system for GME. The panel also said that speakers in favor of the report's adoption commended the specific inclusion of continued advocacy for training in nonhospital sites.

The AMA house also adopted a medical education council report on resident and fellow duty hours (see page 20 of 155-page PDF; About PDFs) that includes recommendations consistent with AAFP policy.

The AMA action follows the December 2008 Institute of Medicine, or IOM, report, Resident Duty Hours: Enhancing Sleep, Supervision and Safety, which calls for reducing the maximum number of consecutive hours that residents can work to 16 and for allowing overnight call only with a 5-hour nap requirement.

Similar to AAFP policy and advocacy, recommendations in the report direct the AMA to call for further research into protected sleep periods during prolonged in-house call and to encourage the ACGME to not adopt the IOM report's proposed new duty hour limits. According to the AMA council report, the additional IOM limits "could have significant unintended consequences for continuity of patient care and safety, as well as being difficult and expensive to implement and monitor."

In addition, the council report recommends, the AMA should urge that "any costs of further duty hour limits be borne by all health care payers and that any proposed changes to the ACGME standards have adequate funding prior to implementation."

AAFP Board Chair Ted Epperly, M.D., of Boise, Idaho, an Academy delegate to the AMA who has testified on resident duty hours before the ACGME, told AAFP News Now, "We were pleased with the report and the reference committee recommendations. They were very close to our own."

The delegates also adopted recommendations included in a third Council on Medical Education report that addresses the availability of clinical training sites for medical student education (see page 61 of 155-page PDF; About PDFs) in light of increasing enrollment at U.S. medical schools.

The report recommends that the AMA work with the Association of American Medical Colleges and the American Association of Colleges of Osteopathic Medicine to encourage local, state and federal governments and private sector philanthropies to provide additional funding to support infrastructure and faculty development for medical school expansion.

In other actions, the AMA house adopted resolutions that