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Am Fam Physician. 2014;90(9):613

AAFP Presses for GME System Reform

The American Academy of Family Physicians (AAFP) recently released a proposal that aims to strategically reform the nation's graduate medical education (GME) system. The AAFP proposal urges policymakers and stakeholders to take the following five actions: (1) limit direct GME and indirect medical education payments to training for “first-certificate” residency programs that train physicians in one of 25 specialty areas such as family medicine, pediatrics, psychiatry, and internal medicine, and are foundational to additional subspecialty training; (2) establish primary care thresholds and “maintenance of effort” requirements applicable to all sponsoring institutions and teaching hospitals that currently receive Medicare or Medicaid GME financing; (3) require all sponsoring institutions and teaching hospitals seeking new Medicare- and Medicaid-financed GME positions to meet primary care training thresholds as a condition of expansion; (4) align financial resources with population health care needs through a reduction in indirect medical education payments and allocation of those resources to support innovation in GME; and (5) fund the National Health Care Workforce Commission. For more information, go to

Are Community College Students Being Overlooked by U.S. Medical Schools?

Students who attended community college after high school were less likely to gain entrance into medical school than students who studied at a community college during high school, after college graduation, or not at all, according to a recent study published in Academic Medicine. Researchers set out to discover the role community colleges have as a pathway to medical school admission. The primary outcome measure was acceptance to a U.S. allopathic medical school or medical scientist training program. Additional outcomes were students' plans to practice in an underserved community or to work primarily with minority populations. Of the 17,518 students (out of 40,491 applicants) who matriculated into medical school in 2012, 11% attended community college during high school, and 12% attended community college after graduating from a four-year university. However, only 5% attended community college after graduating from high school. For more information, go to

Many Family Physician Jobs Unfilled

Demand for family physicians continues to grow, and many institutions are left with unfilled positions because of the intense competition, according to a recent survey. Family physicians were the most sought after position in 2013, followed by hospitalists and internists, the Association of Staff Physician Recruiters found. In all, 70% of organizations surveyed searched for a family physician last year. In addition, the percentage of primary care positions overall that go unfilled each year is increasing. Specifically, the percentage of family physician positions that went unfilled rose from 36% in 2012 to 47% in 2013. The survey detailed more than 5,000 physician and advanced practice nurse searches by 145 health care organizations across the country. For more information, go to

MedPAC Remains Optimistic About ACOs, Despite Only Modest Savings

As eager as federal officials may be to introduce new Medicare payment methods to control health care costs, members of the Medicare Payment Advisory Commission (MedPAC) recognize that evidence of real savings will take several years to achieve. MedPAC commissioners recently discussed the performance of accountable care organizations (ACOs) and how to create more incentives to ensure their success. Based on the latest statistics from the Centers for Medicare and Medicaid Services, 348 ACOs are participating in the Medicare Shared Savings Program, covering an estimated 5 million patients. Early returns on cost savings are modest, with average savings recorded from all ACOs at 0.3%. About 15% of participants reported savings between 2% and 5%, and about 10% yielded savings between 5% and 10%. Most ACOs fell within a range of a 2% loss and a 2% gain. Despite the modest savings, however, most commission members expressed support for their operation and sought ways to improve performance. MedPAC officials said it will take one or two more years of data before they have an adequate timeframe from which to draw conclusions about performance. For more information, go to

— AFP and AAFP NEWS staff

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