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Is GME Snubbing Rural America?



Theories abound as to why young physicians won't practice in rural areas. But the key reason why young medical doctors don't fill these much-needed roles readily is a lack of accountability in publicly funded Graduate Medical Education programs, researchers suggest.



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.
Sandra Phillips Sperry (6/20/2013 at 7:01 PM)

Rural medicine/health care is as different from urban medicine as the life style in those differing areas...and it should be noted the income/salary levels are also quite different. To give credit to the committed rural MD's practicing and the people supporting them, there are challenges in the context of available support services in an industry that has turned very high tech. The major issue is not the lack of support from GME but the ability to provide an infrastructure(whether virtual or immediate) that supports currents practice. This is one arena where innovative perhaps disruptive solutions need to be identified.
Jay in Ca (6/20/2013 at 2:05 PM)

This is what is wrong with these academic types. these people have never ran a business/practice. They get paid no matter what drivel they put out in their "research." I have one word for these Einstein's- VOLUME! Medicine is a volume business and now with all of the regulation from Obamacare. Who can afford a 60K EMR when they get paid 18 cents on the dollar from Medicare, assuming they have and EMR, e-prescribe( or get an exemption) and now perform the mandatory PQRS reporting. And if not get penalized 1.5% in 2015. And Medicaid is worse, getting only about 9-12 cents on the dollar. This is why I will either quit medicine or go to a Cash only business.
sandra (6/19/2013 at 10:39 PM)

I agree with the forst poster. Here is another thought [INVALID]- maybe you health policy wonks and thought leaders have finally made it so blasted unpleasant and thankless to be a primary care doc, that nothing will convince a smart young person to commit to such a life. Think about it all you health policy gods
Chip Haubrock (6/19/2013 at 6:48 PM)

"It's a shame that articles like this are allowed to even be printed." Huh? Are you saying there's no way to make GME funding conditional based on recruitment of doctors who agree to help meet societal needs?
16788044 (6/19/2013 at 3:50 PM)

Really, you're blaming in affect the college/university (although in this case it's a hospital) for physicians that don't want to live in a rural area or be an IM physician. I'm sure somewhere you have some valid points, but none of them are reflected in this article. You start out be noting many reasons why doctors don't practice in rural areas, and follow it up by saying that it's the school's fault for not selling them on doing it anyway. It's a shame that articles like this are allowed to even be printed. This person obviously wants to make a biased point that will make alot of people upset who don't care to see the reality. I have a couple of questions for you doctor, are you practicing what you preach; do you live in a rural area providing for the underserved; are you in IM? There are other points that I could throw out but it's not worth it.