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Family Medicine Organizations Ask Congress to Implement New Policies for GME Reform

September 15, 2014—The Council of Academic Family Medicine and the American Board of Family Medicine joined with the American Academy of Family Physicians in developing new policy recommendations for graduate medical education that were released today at a Summit on GME Reform in Washington, DC. The organizations jointly request:

  • Expand the number of residency positions for first-certificate residency positions, particularly in needed priority specialties, by limiting direct graduate medical education (DGME) and indirect medical education (IME) payments to the training for first-certificate residency programs, utilizing the savings for expansion.
  • Align financial resources with population health care needs through a 0.25% reduction in IME payments — from the current 5.5% to 5.25% — and allocate these resources to support innovation in graduate medical education.
  • Fund the National Health Care Workforce Commission.
  • Require all sponsoring institutions and teaching hospitals seeking new Medicare- and/or Medicaid-financed GME positions to meet minimum primary care training thresholds as a condition of their expansion.
  • Demonstrate a commitment to primary care through the establishment of thresholds and maintenance-of-effort requirements applicable to all sponsoring institutions and teaching hospitals currently receiving Medicare and/or Medicaid GME financing.

Taken together, these policies allow for a budget neutral method of increasing innovation, right-sizing the physician workforce, promoting more ambulatory/community-based training and primary care production, and rationalizing the use of federal dollars to meet the nation’s health care needs.

CAFM and ABFM have promoted the reform of Medicare GME for more than a decade. With the release of the IOM report on Governance and Financing of GME in July, there is now nationally recognized data and expert opinion to support major changes to the way Medicare GME funding is distributed. There is increasing acknowledgement that these public dollars should be accountable to the health care needs of the American public. 

“Traditional GME financing is not getting the job done. Its rigid formulas don’t allow for the innovation and change required to move medical education to produce physicians with the appropriate training needed to meet current and future needs,” said Tricia Elliott, MD, chair of the Academic Family Medicine Advocacy Committee, and a family medicine residency program director at the University of Texas Medical Branch at Galveston. “Preparation for a rapidly changing practice environment and expansion of the content and sites of training are all needed. In an austere budget climate, we need to better utilize the funding we expend on GME.”

Thomas Campbell, MD, chair of the Council of Academic Family Medicine, and chair of the Department of Family Medicine at the University of Rochester Medical Center, stated, “These policies encourage increased training in ambulatory, community, and medically underserved sites by implementing new methods of funding to include reallocation of existing GME funding that is not calculated according to Medicare beneficiary bed-days. They would provide GME funding directly to primary care residency programs, educational consortia, or non-hospital community agencies and create the proper financial incentives for ambulatory and community-based training.”

“The rules governing the manner in which GME funding is distributed and used have caused a hospital-centric method of training,” said Carlos Roberto Jaén, MD, Chairman of the ABFM and chair of Family and Community Medicine at the University of Texas Health Science Center at San Antonio. “We need reforms in GME funding that will create incentives for training in certain skill areas such as care management, working in teams, supervision of other health professionals, and quality improvement. These skills are needed to promote a more effective and safe health care system.”  

For more information about CAFM’s position on GME reform, contact Hope Wittenberg at, 202-986-3309.

For more information about ABFM’s position on GME reform, contact Bob Phillips, MD, at, 859-269-5626, ext 1253

About CAFM:

CAFM consists of the leadership of the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group and the Society of Teachers of Family Medicine. Through its member organizations, CAFM advances the priorities of academic family medicine.

About ABFM:

The American Board of Family Medicine (ABFM) is the second largest medical specialty board in the United States. Founded in 1969, it is a voluntary, not-for-profit, private organization whose purposes include: improving the quality of medical care available to the public; establishing and maintaining standards of excellence in the specialty of Family Medicine; improving the standards of medical education for training in Family Medicine; and determining by evaluation the fitness of specialists in Family Medicine who apply for and hold certificates. 

Copyright 2018 by Society of Teachers of Family Medicine