Graduate medical education (GME) advocacy

GME is the training that medical school graduates receive as residents in more than 1,000 of the nation’s hospitals and health systems. These are called “teaching hospitals” and they vary in size and specialty focus. GME includes internships, residency and subspecialty and fellowship programs, and it leads to eligibility for state licensure and board certification.

The advent of the Medicare program in 1965 established funding to support the training of medical residents. The federal government spends nearly $16 billion on GME annually through Medicare, Medicaid, the departments of Defense and Veterans Affairs and the Children’s Hospital and Teaching Health Center Graduate Medical Education programs.

Medicare remains the single largest payer with expenditures totaling about $9.5 billion annually, and uses a complex payment formula that includes both direct GME payments and indirect medical education payments based in part on the number of Medicare patients and residents in training.

Effective health care systems have a physician workforce made up of roughly 50% primary care and 50% subspecialty. Today’s U.S. physician workforce is just 33% primary care—making it crucial that tomorrow’s U.S. medical school graduates choose family medicine.

Long-term misalignment of medical education resources has contributed to this crisis and led to disparate care access for patients nationwide. Today’s system excels at educating skilled physicians and physician researchers, but the primary care physician shortage prevents the U.S. from taking advantage of the better outcomes and lower per capita costs associated with robust primary care systems in other countries.

The Teaching Health Center Graduate Medical Education (THCGME) program is among the most successful, efficiently run programs in the country and has trained more than 1,100 primary care physicians, the majority of whom work in areas of high need. That’s because physicians typically practice within 100 miles of where they serve their residencies.

Right now, however, most trainees work in large academic hospitals, exacerbating physician shortages in medically underserved and rural areas. These shortages in turn cause access barriers and disparities in health outcomes for patients in rural and underserved communities.

Without permanent federal funding, most existing THCGME programs would be unlikely to maintain residency recruitment and enrollment, threatening the initial program investments and even the viability of the program itself.