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'Beyond the Walls of the Teaching Hospital'
GME Provides Multiple Benefits to Institutions, Communities, Say Educators
By Barbara Bein
"The community benefits of GME programs extend far beyond the walls of the teaching hospital," Pugno and his co-authors say in the commentary. "Through service to individuals and the community at large, these programs contribute positively in ways far beyond what may be found on the typical hospital revenue and expense report."
Yet hospital administrators don't always recognize these contributions, say the authors. The result? Since 1998, fiscal pressures, including major reductions in federal support, have contributed to the closing of 40 family medicine residency programs and 25 general internal medicine residencies.
This is despite the fact that a residency's teaching clinic often has a "multiplier effect" on its sponsoring hospital. For example, one study showed that for every $1 billed by one such clinic's family physician faculty and residents, $6.40 was billed by local consultants and hospital diagnostic and therapeutic services.
"The absence of having this information is why many programs have closed when their programs are challenged to show 'benefit,'" Pugno told AAFP News Now. "This information is widely known by primary care program directors, but appreciated by few others."
According to the commentary, GME programs affect five target levels: the residents themselves, the sponsoring institutions, the local community, the affiliated academic health center or university sponsor, and the greater community and nation.
Among those benefits are the following:
- Because GME programs serve the medically underserved, they present opportunities to instill in residents a social conscience and a dedication to care for disadvantaged populations.
- Through these programs, sponsoring institutions become eligible for federal, state and grant funds, such as Medicare direct and indirect GME reimbursement, Medicaid GME reimbursement, and Title VII grant funding.
- GME programs bolster their sponsoring institutions' other educational functions, including CME for the medical staff, support for nursing and allied health trainees, and instruction of medical students. The presence of these trainees also provides an opportunity and a rationale to introduce new technology.
- Indirect benefits come in the form of referrals and of cost-avoidance through resident coverage of clinical services. In addition, quality of care may be enhanced because physicians' participation in the exchange of information inherent in teaching opens them up to scrutiny by their colleagues, their students and themselves.
- Donors to health care institutions react favorably to these institutions' efforts to train future health care providers.
- Program graduates who stay in the local community and become active on the medical staff support the institution and local consultants, use local facilities, provide access to care for the medically underserved, and enhance the patient base.
- Teaching programs based in community hospitals provide specialty services through the creation of teaching-specialty and procedural clinics and the inclusion of teaching consultants.
- Direct outpatient services provided by these programs include flu shot clinics, school health programs, preparticipation physical exams, community education services, nursing home support, emergency department follow-up and support for the health care initiatives of the local public health department.
- The primary care base of a community teaching hospital not only supports secondary referrals to its own institution, but tertiary and quaternary referrals to regional health centers and university facilities.
- Many community teaching faculty members generate research and educational funding through grants and contracts, which, in turn, offer venues for such innovative programs as community teaching clinics, rural outreach initiatives and telemedicine projects to remote settings.
- GME programs graduate physicians who are familiar with the resources and procedures offered in their communities. At the regional and national levels, these graduates provide the workforce to replace retiring physicians and promote community growth.
"I believe an appreciation of these benefits by the community members themselves is growing, and that's why health care reform and primary care's role in reform have expanded so quickly," he said.
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