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Is GME Snubbing Rural America?

John Commins, for HealthLeaders Media, June 19, 2013

"GME reform alone will not be the thing that magically fixes the system," Chen says. "But there is a definitely a sense and there is research evidence out there that shows that GME residency training programs can do things that would increase the likelihood of people going into primary care and underserved areas. Where we locate our residency programs and the exposure to different kinds of mentors in GME and the exposure to positive experiences in rural and underserved areas, those do make a difference to trainees."

Chen believes the failure of GME to respond to glaring shortage of primary care physicians will prompt that review.

"The fact remains that there is no accountability in the system currently," she says. "Even with the system the way it is, [could you] layer in an accountability system could that make the difference? It could depending upon what it looks like. There are definitely things going on now. People are looking at GME and they're interested in how you can start to align it with producing the physicians that we ultimately need."

Simply building more accountability into GME and ignoring other issues such as compensation won't remove all the hurdles that keep physicians away from rural America. But it's a good start and it's long overdue.


John Commins is a senior editor with HealthLeaders Media.

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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.