COGME Report Puts Family Medicine on Priority List
In family medicine, we've known for years that the United States isn't getting the proper return for its $13 billion annual investment in graduate medical education. Federal funds paid to hospitals for training purposes too often result in the expansion of the subspecialty residencies hospitals need to maximize their own bottom lines -- cardiologists, radiologists and a slew of other "ologists" -- instead of producing the balanced workforce our health care system actually needs.
If legislators haven't already heard this message from the AAFP, the Council on Graduate Medical Education (COGME) -- which was created by Congress to provide assessments of physician workforce trends and training issues -- has recently spelled it out for them again.
Three years ago, COGME released a report that highlighted the worsening shortage of primary care physicians and recommended addressing the shortage by narrowing the gap in incomes between primary care physicians and subspecialists and reforming medical education.
In a new report released last month, the physician-led panel continued its call for more primary care physicians. In doing so, COGME was critical of Congress for underinvesting in GME. It also took aim at teaching hospitals for not emphasizing primary care and offering curriculum that was inadequate in related areas, including population health, care coordination and team-based care. COGME also questioned why national accrediting organizations have not taken the lead in bringing about these necessary changes.
There are numerous recommendations in the 28-page report, and we will have a more detailed report this week in AAFP News Now. But here are a few highlights:
- COGME recommends that Congress should continue funding existing GME positions and increase funding to support 3,000 more graduates per year.
- The report recommends that overall GME funding be prioritized based on workforce needs, specifically calling for family medicine and other "high priority specialties" and for programs whose graduates go on to practice in underserved areas.
- The report also recommends that any increases in GME funding should be directed toward training programs that produce a high proportion of physicians who continue in one of the prioritized specialties, which also include geriatrics, general internal medicine, general surgery, pediatric subspecialists and psychiatry.
COGME's recommendations are well timed. The Institute of Medicine is expected to release a review of the governance and financing of GME early next year. That report, which was requested by Congress, should prompt legislative reform.
The need is clear. Despite the fact that more than half of patient visits are for primary care, only 7 percent of U.S. medical school graduates are choosing careers in primary care. A study published last year in the Annals of Family Medicine stated that the United States will need more than 50,000 additional primary care physicians by 2025 -- 33,000 to account for population growth, 10,000 to accommodate an aging population and more than 8,000 just to care for people who will be newly insured because of health care reform.
Additional residency positions also are needed to keep pace with number of new medical schools and expanding medical school class sizes. In fact, by 2016, the United States likely will have more medical school graduates than residency slots!
Tax payers are investing billions of dollars each year in physician training as a public good. For this level of investment, shouldn't we expect a physician workforce that meets our country's needs?
Jeff Cain, M.D., is President of the AAFP.