Graduate Medical Education Funding Is Not Helping Solve Primary Care, Rural Provider Shortages, Study Finds

Jun 19, 2013, 9:00 AM

From 2006 to 2008, 158 of the country’s 759 residency sponsoring institutions and teaching sites did not produce any primary care graduates, according to a study published online last week by Academic Medicine. Less than one-quarter of medical school graduates entered primary care during those years.

The study also found that physician shortages in rural and underserved areas persist; only 4.8 percent of 2006-2008 graduates practice in rural areas. Nearly 200 institutions produced no rural physicians, more than half produced no Health Service Corps graduates, and 283 produced no physicians practicing at Federally Qualified Health Centers or Rural Health Clinics.

Graduate medical education (GME) distribution is uneven, the researchers found, and provides more support to subspecialty programs than to primary care programs. The top 20 primary care producing institutions (where 41 percent of graduates were in primary care) received $292 million in total Medicare GME payments, while the bottom 20 (where only 6.4 percent of graduates were in primary care) received $842 million in these funds.

The production of primary care and rural physicians “will not sustain the current workforce, solve problems of maldistribution, or address acknowledged shortages,” the authors write.

“Medicare GME financing is the largest public investment in health care workforce development in the nation, with two-thirds of nearly $10 billion in annual funding going to the 200 hospitals training the largest number of residents,” they continue. “Despite this funding, the physician workforce continues to face critical shortages in specific specialties and locations, most of which are minimally served by the graduates of those 200 hospitals. As a result, Medicare GME-funded institutions face increasing scrutiny and calls for greater accountability… These outcomes can be used to develop an accountability system, inform policy and education, and evaluate the results of changes in the GME system.”

“Toward Graduate Medical Education (GME) Accountability: Measuring the Outcomes of GME Institutions” was written by Candice Chen, MD, MPH; Stephen Petterson, PhD; Robert L. Phillips, MD, MSPH; Fitzhugh Mullan, MD; Andrew Bazemore, MD, MPH; and Sarah D. O’Donnell, MPH.

Read the study in Academic Medicine.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.