Is GME Snubbing Rural America?
"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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