By tracking the career paths of physicians who completed residency sponsored by one Michigan institution, recent research showed how spending on graduate medical education (GME) in a specific state contributes to physicians practicing in that state.
Researchers tracked the career path of 2000-2014 graduates of 18 GME training programs sponsored by Grand Rapids Medical Education Partners for the study(www.jgme.org), which was published in the Oct. 1 issue of the Journal of Graduate Medical Education. Slightly more than 40 percent of the 1,168 graduates who were tracked went on to practice primary care -- defined as family medicine, internal medicine, internal medicine-pediatrics and pediatrics -- which is consistent with the recommendation issued by the Council on Graduate Medical Education to support future workforce needs. Of these 476 primary care graduates, nearly 60 percent practiced in Michigan during their career.
Almost 88 percent of all physicians in the study who completed both their undergraduate and medical education in Michigan chose to practice in the state at some point.
The study's authors pointed out that the majority of GME funding comes from Medicare and Medicaid, and they argued that its value is enhanced if it helps retain physicians in the area where they complete residency. But these programs are frequent targets of proposed budget cuts.
"There is bipartisan support for reducing Medicare costs, and cuts to GME funding are regularly proposed as a means to achieve this goal," the authors wrote. "In addition, some states have reduced or proposed reductions in Medicaid support of GME, while others have eliminated this source of funding altogether."
Michigan provided a unique case study because although its population declined between 2000 and 2010, medical school admissions increased 30 percent between 2005 and 2010, Andrew Bazemore, M.D., M.P.H., director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, wrote in an accompanying commentary on the research(www.jgme.org). Allopathic and osteopathic medical school enrollment in Michigan jumped nearly 50 percent between 2002 and 2014.
Bazemore noted that the study makes a strong case for expanding training to physician shortage areas that lie outside traditional academic health center locations.
"Many have suggested that such public investments come with the expectation of public returns," he wrote. "Public investment in training should be matched with public expectations that training will produce the right providers capable of delivering the right services in the right places."
But without a national planning agency to manage how GME funding is spent, local needs are not being met by the U.S. system of medical training dominated by teaching hospitals. Bazemore pointed to Health Education England and Health Workforce Australia as two examples of national agencies that help allocate resources according to regional needs. In the United States, by contrast, the federal government spends $16 billion annually on GME without ensuring that this public revenue is used to meet health needs.
"There is evidence to suggest that this may lead to GME that favors a hospital's immediate patient care needs and financial interests over public need," Bazemore wrote.
In reviewing the Michigan study, Bazemore went a step further than the researchers, emphasizing that GME support should be consistent with a state's public health needs. Michigan residents are funding the expansion of their state's medical schools while also shouldering higher Medicaid costs and the residual effects of Detroit's bankruptcy, he wrote, and they should expect that graduates will provide the services that their aging and increasingly insured population requires.
"The rapidly expanding primary care safety net, exemplified by the federally qualified health centers that served some 600, 000 Michiganders in 2015, is perpetually short of physicians," Bazemore wrote.
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