The Physician Workforce and Financing of Graduate Medical Education

doi:10.1059/0003-4819-128-2-199801150-00012

The Physician Workforce and Financing of Graduate Medical Education

American College of Physicians. This paper, written by Jack A. Ginsburg, MPE, was developed for the American College of Physicians Health and Public Policy Committee (HPPC) and the HPPC Workgroup on Physician Workforce and Financing of Graduate Medical Education. Members of the HPPC were Whitney W. Addington, MD, FACP (Chair); Phillip D. Bertram, MD, FACP (Vice-Chair); John M. Eisenberg, MD, MACP; William M. Fogarty, MD, FACP; Nancy E. Gary, MD, MACP; David J. Gullen, MD, FACP; Janice Herbert-Carter, MD, FACP; Richard Honsinger Jr., MD, FACP; Stephan L. Kamholz, MD, FACP; Derrick L. Latos, MD, FACP; Risa J. Lavizzo-Mourey, MD, FACP; Wayne J. Riley, MD, MPH; Richard K. Tompkins, MD, FACP; and James Webster Jr., MD, FACP. Ex officio members were Gerald E. Thomson, MD, MACP (Immediate Past President); Christine K. Cassel, MD, FACP (President); William A. Reynolds, MD, FACP (President-Elect); and Jock Murray, MD, FACP (Chair, Board of Regents). The HPPC Workgroup consisted of Stephan L. Kamholz, MD, FACP (Chair); Whitney W. Addington, MD, FACP; Janice Herbert-Carter, MD, FACP; Faroque A. Khan, MD, MACP; Jaan Sidorov, MD, FACP; Jay S. Skyler, MD, FACP; Lawrence G. Smith, MD, FACP; Neal Vanselow, MD, FACP; and Michael Whitcomb, MD. This paper was approved by the Board of Regents on 19 March 1997. Note: This is an abridged version of the position paper approved by the American College of Physicians Board of Regents. For copies of the full text, contact Jack A. Ginsburg, MPE, American College of Physicians, 700 Thirteenth Street, NW, Number 250, Washington, DC 20005. Requests for Reprints: Jack A. Ginsburg, MPE, American College of Physicians, 700 Thirteenth Street, NW, Number 250, Washington, DC 20005.

Abstract

This paper addresses key issues concerning the physician workforce and the financing of graduate medical education.The American College of Physicians recommends the establishment of a national advisory organization to develop a coherent and coordinated national policy on the health professions workforce. Given the increasing oversupply of physicians, the College recommends that no new medical schools be created, that total enrollment in U.S. medical schools not increase, and that the number of international medical graduates entering residency training in the United States be restricted. All health care payers should share the cost of graduate medical education, funding should be predictable and stable, and funding should include ambulatory training sites. The number of first-year residents should be linked more closely to the annual number of medical graduates in the United States, and Medicare payments for medical education and training should be made only to the health maintenance organizations that actually incur these costs. The College advises that hospitals providing care primarily to underserved populations and indigent persons need stable funding with which to pay for personnel to replace residents.

The College calls for research to evaluate the feasibility of establishing a voucher system, in which each resident would receive payment authorization certificates to fund training at accredited residency sites.Additional research is also recommended to distinguish the individual costs involved in graduate medical education from other costs associated with graduate medical education and the costs of care of indigent persons.