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AAFP calls for medical education reform

Current system fails to produce enough primary care physicians to meet U.S. healthcare needs

The current hospital-based system of graduate medical education does not meet the needs of modern healthcare delivery or the training of the future physician workforce, according to a new reform proposal by the American Academy of Family Physicians.

Hospitals will always play an important role in the health delivery and medical education system, but they should no longer be the focal point, the AAFP argues. The United States must build a system better designed to train the next generation of physicians in care settings that afford them the skills they will need to deliver high quality care to their patients, the AAFP proposal says.

“Reform of a 50-year-old program will be difficult and there are numerous ideas on how reform should occur,” said Jeffrey J. Cain, MD, FAAFP, chair of the AAFP Board of Directors. “Today, the AAFP is sharing our proposal and adding our voices to a growing debate on this important issue.”

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The AAFP proposal, Aligning Resources, Increasing Accountability, and Delivering a Primary Care Physician Workforce for America, calls for greater accountability and transparency in the GME system and an alignment of national investment in meeting the physician workforce needs of the country. The proposal also creates a mechanism to ensure that the training of physicians occurs in the most appropriate settings and not solely in a hospital.

“While our current system excels at educating and training highly skilled specialists and physician researchers, it fails to produce enough primary care physicians to meet the healthcare needs of our nation,” said Cain. “The AAFP isn’t suggesting that our nation’s GME system has failed. We are suggesting that our GME system has excelled at what it was designed to promote, but it is time to change those incentives.”

The AAFP proposes the following changes in the financing of GME to align taxpayer dollars with the training of primary care physicians:

  1. Limit payments for direct graduate medical education and indirect graduate medical education to training for first-certificate residency programs.
  2. Establish primary care thresholds and maintenance-of-effort requirements for all sponsoring institutions and teaching hospitals currently receiving Medicare and Medicaid GME financing.
  3. Require all sponsoring institutions and teaching hospitals seeking new Medicare- and Medicaid-financed GME positions to meet primary care training thresholds as a condition of residency program expansion.
  4. Align financial resources with population health care needs through a reduction in IME payments and allocation of those resources to support innovation in GME.
  5. Fund the National Health Care Workforce Commission.

“It is important that our national investment in GME supports a system that is transparent, accountable and meets the healthcare needs of our citizens,” noted Cain. “These recommendations will transition our GME system away from a hospital-based system and toward a robust, community-based system that trains physicians to be well positioned to provide care to our growing and aging population.”