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

2. 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

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

4. 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

5. 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

6. 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

7. 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)

8. GME Medicaid Funding in Arizona YearFundingNumber of Hospitals 2006 $22 million13 2007 $33 million16 2008 $68 million15 2009 $81 million15 2010 $86 million 5 2011$113 million 6 2007 legislation authorizes IGTs; money begins flowing in 2008 2008 hospitals begin receiving funds for indirect costs 2010 GF support eliminated; all GME funding coming through IGTs

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

10. National Physician Shortage* *AAMC, 2010

11. Arizona’s Physician Pipeline ArizonaU.S. Physicians per 100,000 220259 Residents per 100,000 22 36 Medical Students per 100,000 30 31 Arizona must add 850 residency positions to bring up to national level of 36 per 100,000 persons

12. 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

13. Delivery System Transformation Professional Silos Clinical Integration Coordinated Care

14. 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

15. 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

16. Questions?