GME Provides Multiple Benefits to Institutions, Communities, Say Educators

At a time when more hospitals are being forced to consider closing their primary care residency programs for financial reasons -- and many already have -- the full economic impact of graduate medical education, or GME, programs has not been appreciated, says one family medicine educator. GME programs provide numerous direct, indirect and intangible benefits to physician-trainees themselves, their sponsoring institutions, university sponsors, and local and wider communities.

In a commentary in the June Journal of Graduate Medical Education, Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education, said the best elements of GME programs go beyond hospital-generated profit and loss statements.

"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:

Although many of these benefits are not widely recognized, Pugno said he remains optimistic about the future of GME programs -- especially in the health care reform environment that now is unfolding.

"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.