1. Tips from the Trenches about Adding or Growing GME
Perspectives from UTHSCSA from the roll out of four new GME programs in South Texas – Robert J. Nolan MD and the San Antonio GME Team

2. Essentials for the GME naïve hospital
A firm understanding of the benefits and limitations of “cap – building” -- knowledgeable legal consultation
Which entity will be the Sponsoring Institution (SI)
If the hospital is not the SI – a robust and clearly delineated understanding of the roles of the SI and the participating hospital(s)

3. CMS DGME and IME funds do not begin to flow until after the residents are in place
Loss-leader annual funding for startup:
DIO salary/benefits
Program Director(s) salary/benefits
Program Coordinator(s) salary/benefits
Core faculty support
Resident salaries/benefits for initial start up year or two

4. One-time Non-personnel costs
Hospital renovations – call rooms, conference rooms, offices for residents/faculty
Clinic renovations/lease – Family Medical Center
Faculty recruitment
Faculty development
Consultation/Legal fees
ACGME application fees

5. Challenges for GME programs at naïve hospitals
All hospital politics are local
The belief among community practitioners that “understand” residency training
Compensation issues: practitioner salaries vs. academic salaries
Diversity and complexity of patient populations at community hospitals
Availability of required procedures

6. Facilitating new GME programs at naïve hospitals
Faculty Development – teaching skills, assessment, evidence-based practice, team skills
Scholarship – presentations, publications, peer-reviewed extra-mural funding, etc.
Professional Development – Nurses, Lab Technicians, OR and L&D personnel, etc.
Quality Improvement and Patient Safety activities – ACGME Clinical Learning Environment Review

7. Why develop new GME programs at naïve hospitals?
Potential Return on Investment:
Better quality of care
Increased complexity of care (tertiary)
Recruitment of nationally recognized physicians
Increased referral rates (from graduates and as a result of new service lines)
Reduction in recruitment costs via retention of graduates
Care of the underserved and community service projects
Market differentiation – increase in public opinion, perceived value and prestige