The AAFP and four other family medicine organizations are praising the Josiah Macy Jr. Foundation for its recent "call to action" to change the U.S. graduate medical education, or GME, system to make it more responsive to the needs of the American people.
In a letter to Macy Foundation President George Thibault, M.D., the AAFP, the Association of Family Medicine Residency Directors, the Association of Departments of Family Medicine, the North American Primary Care Research Group and the Society of Teachers of Family Medicine lauded the release of Ensuring an Effective Physician Workforce for America: Recommendations for an Accountable Graduate Medical Education System, which summarizes the findings of a conference presented in October 2010 by the Macy Foundation and the Association of Academic Health Centers.
"Your work indeed is a 'call to action' to the health care leaders of this nation for focused efforts to evolve forward the U.S. graduate medical education system toward one that is more accountable, flexible and responsive to the needs of the American people," said the groups in their letter.
According to the conference summary(www.josiahmacyfoundation.org), the size and specialty mix of the physician workforce likely will become increasingly insufficient in the coming years because of such factors as a growing chronic disease burden spurred by the nation's aging population and other factors, as well as the greater availability of health insurance under the Patient Protection and Affordable Care Act.
Specifically, the summary notes that reports recently issued by various medical education groups and federal government agencies project that the current supply of new physicians entering practice each year "is not adequate to avoid a significant shortage in the years ahead." Moreover, these and other reports indicate that the specialty mix of physicians entering practice "is not in keeping with the needs of the population."
"Due to a number of driving forces, physicians currently being trained and those (who) are entering the workforce are increasingly choosing to pursue subspecialties rather than the core specialties of general internal medicine, family practice, general pediatrics and general surgery," says the conference summary.
In addition, several government agencies and advisory bodies have called for modifications in residency training to ensure that residents are being trained to provide safe, high-quality, evidence-based care in today's changing health care system, according to the summary, which also notes that four major specialties -- family medicine, general internal medicine, general pediatrics and general surgery -- long have had initiatives that aim to redesign residency training in their respective specialties to better prepare their residents for practice.
Overall, GME is a "public good," the summary concludes, and, as such, must be accountable to the needs of the public. Moreover, there is a need to ensure an adequate number of physicians are trained, as well as a need for an external review of the governance and financing of the current GME system.
The summary offers the following recommendations:
- ensure that the physician workforce is of sufficient size and specialty mix;
- provide trainees with needed skill sets through the use of innovative training approaches and sites;
- undertake an independent external review of the governance and financing of GME;
- allow GME to be redesigned through accreditation policy; and
- gauge the implications to GME funding of ensuring adequate numbers and distribution of physicians.
In their letter, the Academy and the other organizations said they were pleased to see a number of items in the recommendations for which they have advocated, including a call for more GME positions targeted at primary care and less burdensome residency accreditation policies; more financial support for GME from all entities that benefit from it; and a focus on leveraging GME funding to provide training in the most needed specialties -- namely, primary care and general surgery.
AAFP Vice President for Education Perry Pugno, M.D., M.P.H., told AAFP News Now that changes in GME funding are especially important because the funding greatly influences decisions by teaching hospital leaders.
If medical educators "are to be held accountable for the outcomes of that funding, perhaps the decisions by those leaders will better reflect addressing the needs of the nation," he said.
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