The Association of American Medical Colleges yesterday unveiled a five-year plan to revamp graduate medical education, and the plan includes action goals not only related to training the right kind of doctors, but also to identifying the costs and benefits of GME.
Despite a new Commonwealth Fund report that concludes there likely will not be a primary care physician shortage as a result of the coverage expansion from the Affordable Care Act, many others are concerned that there will be a lack of primary care doctors.
And while I have argued that the presumed doctor shortage may be eased by expanded use of advanced practice nurses and physician assistants, that doesn't mean that the supply of doctors being produced by residency and fellowship programs matches the needs of the evolving health care system. Newly minted physicians probably are going to continue to gravitate toward specialties that offer the best combo of rewarding work and compensation as the field currently stands, not necessarily how it will look 10 years out.
Janis Orlowski, M.D., chief health care officer for the AAMC, says they will be rolling out some workforce projections in the coming weeks that will inform efforts to get the supply and demand of physicians in better alignment. Orlowski says the AAMC cannot formally alter the mix of residencies and fellowships being offered, but it can make moves that create incentives for schools and students that inform decision-making. The AAMC has some funding mechanisms it can use to alter which specialty training programs are offered, while for students, creating mentoring opportunities and positive clinical experiences can help to inform where they want to train, she says.
So, getting the backing of the AAMC to review the process is a welcome step in gaining recognition of the current and future mismatches in expertise supply and demand.
Along the same lines, tabulating the costs and benefits of a complicated Medicare-funded GME program may shed some light on ways that funds are not being used as efficiently as they should, while highlighting the ways hospitals are adding value in education. Orlowski says the AAMC is in favor of continuing to establish the appropriate accountability for support of GME. "We have a responsibility to be accountable," she says. The AAMC's plan includes five other goals for improving GME.
Susan Skochelak, M.D., group vice president for medical education at the AMA, says the consortium of schools that received AMA grants under the program meets twice a year to share ideas.
Skochelak highlighted a couple of interesting innovations already being tested and shared by med schools in the initiative.
Penn State College of Medicine is training medical students as patient navigators to give them an improved perspective on the challenges patients face. "That's a whole new way of teaching future physicians," she says.
Meanwhile, med students at New York University School of Medicine can take a class called Health Care by the Numbers in which they learn how to turn raw data into information. In that class, they learn how to determine the cost of a vaginally delivered baby in New York, and analyze why the average cost in Manhattan is seven times the cost in the rest of the state, she says. "That's just the first day of the class," she says. We want to see this thing quickly tried at other places, both inside and outside the consortium, Skochelak adds.