Graduate Medical Education What It Is Why It Matters Possible Solutions Greater Phoenix Chamber of Commerce November 19, 2012

GME Defined Physician education is a two-step process: 1.Completion of an educational program at an accredited medical school 2.Completion of postgraduate training at a hospital or other healthcare institution, followed by national exams Postgraduate education=GME

Road to Physician Workforce Undergraduate Degree: 4 years Medical School: 4 years GME/Residency: 3 to 7 years

GME Basics Doctors in GME are called residents or fellows 9000 GME programs in 26 specialties (e.g., Internal Medicine, Family Medicine, General Surgery, Pediatrics, OB/GYN, etc.) All 50 states and US territories require GME for physicians to become licensed to practice 110,000 resident physicians in the US

Why GME Matters Access to medical care depends on a sufficient physician workforce A robust physician workforce contributes to a community’s economic development Physicians often choose to practice where they train

Who Funds GME Primary Sources of Federal Funding: Medicare –$9.5 billion to teaching hospitals capped at 100,000 positions in 1997 –$3 billion: direct payments to cover resident stipends, expenses –$6.5 billion: indirect medical education adjustment; added costs in patient care associated with training Veteran Affairs & Department of Defense (12,000 residents) HRSA – Children’s GME

Who Funds GME Other Funding: Medicaid (State $$ plus FMAP) –2005: 47 states provided $3.78 billion –2009: 41 states provided $3.18 billion –9 additional states considering ending payments Private (hospital supported)

GME Medicaid Funding in Arizona YearFundingNumber of Hospitals 2006 $22 million $33 million $68 million $81 million $86 million $113 million legislation authorizes IGTs; money begins flowing in hospitals begin receiving funds for indirect costs 2010 GF support eliminated; all GME funding coming through IGTs

Trends and Transformation: Factors Impacting GME and the Physician Workforce Physician shortage Specialization Healthcare delivery transformation State and federal budget pressures

National Physician Shortage* *AAMC, 2010

Arizona’s Physician Pipeline ArizonaU.S. Physicians per 100, Residents per 100, Medical Students per 100, Arizona must add 850 residency positions to bring up to national level of 36 per 100,000 persons

Other Considerations: Specialization Increasingly, physicians are electing to practice in subspecialties 2001: subspecialties accounted for 49% of total residency programs and 13% of residents 2011: subspecialties accounted for 55% of total residency programs and 17% of residents

Delivery System Transformation Professional Silos Clinical Integration Coordinated Care

Budget Pressures & Funding Hole 1997 Medicare cap 2010 elimination of state general fund support for Medicaid GME Current federal deficit discussions: proposal to cut Medicare IME Hospital funds and IGTs

Options for State Moving Forward GME Funding Estimates: – $50 million TF to support current residencies – $140 million TF to support residency expansion (850 slots) Funding Options Development of an academic medical center/system in Phoenix

Questions?