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Is GME Snubbing Rural America?

John Commins, for HealthLeaders Media, June 19, 2013

The study's findings are blunt: GME operates on public money—nearly $10 billion in funds from the Medicare program and another $3 billion from Medicaid—but apparently the nation's teaching hospitals can't address physician shortages that were identified and anticipated decades ago.  

The problem is not just in rural and underserved areas. Chen says GME institutions produce primary care physicians at an "abysmally low" rate. This failure by a taxpayer funded program to address a dire public need is occurring despite the full knowledge that the need for primary care physicians will dramatically increase in the coming years as more Americans gain health insurance coverage under the Patient Protection and Affordable Care Act.  

"If residency programs do not ramp up the training of these physicians, the shortage in primary care, especially in remote areas, will get worse," Chen says. "The study's findings raise questions about whether federally funded GME institutions are meeting the nation's need for more primary care physicians."  

"Right now with the Medicare money that goes for GME there is very little requirement around that money other than that you train and report that you train 'X' number of residents," Chen says.  

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8 comments on "Is GME Snubbing Rural America?"


Robert C. Bowman, M.D. (7/2/2013 at 3:45 PM)
GME snubs about half of Americans who are most in need of primary care and workforce trained in their state and in locations where they live. 3.5% of the land area or 3400 zip codes with 35% of the population has 95% of GME positions, 72% of physicians, over 75% of health spending, and over 85% of GME positions. Medical Education economic impact was tracked by AAMC and you can estimate 100 zip codes with half of this impact or 250 billion a year of 500 billion total. All but a few states have insufficient to grossly insufficient GME to meet state needs - and we know that instate GME is the best predictor of instate practice location. Family medicine is also the best instate multiplier, the best primary care multiplier, and the best primary care where needed multiplier but FM remains 3000 annual graduates - because of the designs. It is not just rural, and frankly there are about 9 rural counties that do very well because the do GME like the big institutions. It is about most Americans left behind by design - especially GME.

Anthony Day (6/21/2013 at 10:07 AM)
The problem with this article is the idea that GME is a monolithic institution that chooses what to train physicians to do. It is simply supply and demand. There is still enough demand for specialist physicians (and enough pay) to convince medical students to compete for those positions rather than the primary care positions for training. We can't add more positions for primary care training unless their are physicians to fill them. We could shift GME funding out of lucrative specialties and fund the training of primary care physicians effectively. That is a legislative problem with our system of Government control of healthcare - not a GME problem.

Steven (6/20/2013 at 8:36 PM)
This article makes very little sense. The problem is not trying to justify the training dollar amounts to why physicians want to practice in rural areas. The truth is that less than 5% of the population wants to live in communities of 10,000 or less. In order to sacrifice amenities (schools, restaurants, lifestyle options, etc.) there must be an incentive. Unfortunately, the compensation, quality of life (call), etc. do not justify living in a small community for most. Money or training will not solve this problem. Incentives can help. It will be a sad day for rural America when pay is equal in desired and undesired areas. The effect will result in even fewer rural physicians.