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Is GME Snubbing Rural America?

John Commins, for HealthLeaders Media, June 19, 2013

"There is nothing that says we need more primary care doctors or other kinds of doctors. General surgery is another area where a lot of communities are struggling. There is nothing in the payment that says you need to produce these kinds of doctors or produce doctors who are going into certain areas to serve the need that America has."  

Consider these findings from Chen and her colleagues:

  • The top 20 primary care producers in this study trained 1,658 primary care doctors out of a total of 4,044 or 41%. These sites received just $292 million in GME funding.
  • The bottom 20 programs produced only 684 primary care graduates out of 10,937 or 6.3%. These sites received $842 million in GME payments—an amount that reflects not a dedication to training doctors in primary care but in churning out highly paid specialists who typically practice in big cities or the suburbs.
  • Almost two-thirds of the nearly $10 billion in Medicare funding for GME annually goes to 200 hospitals—and those sites perform poorly when it comes to producing primary care doctors.

Chen and her colleagues say policymakers should examine the skewed incentives that have led to the ongoing primary care crisis and the lack of physicians in underserved areas, and develop a more accountable GME system. Of course there are other nagging issues out there that disincentivize primary care, especially the huge compensation gap between primary care physicians and their specialist colleagues.  

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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.