Reform of graduate medical education has been raised as a potential agenda item for the 114th Congress.
In an open letter released Dec. 6, 2014, eight members of the House Energy and Commerce Committee’s Health Subcommittee requested input on the structure, financing, and governance of graduate medical education. In order to frame and organize the responses, the members posed seven specific questions. Over a period of several weeks, through a process incorporating input from more than 250 Fellows in leadership positions, the ACS Health Policy and Advocacy Group, faculty of the University of North Carolina’s Cecil G. Sheps Center for Health Services Research, Chapel Hill, and ACS staff of both the Chicago and Washington offices, a letter on behalf of ACS was drafted and submitted on Jan. 15, 2015. The submitted response not only provided answers to the seven questions but also included a set of principles that ACS advocates should guide reform efforts. Those principles are as follows:
1. Education and training are essential mechanisms in the process by which new medical discovery and excellence in new therapy are achieved. In order to foster and preserve the innovation for which our country’s medical system is noted, graduate medical education (GME) should continue to be supported as a public good.
2. Surgical GME has unique needs linked to the skills training required for an additional set of technical competencies. Accordingly, in order to acquire and achieve mastery of those skills, it is imperative that those unique training needs be recognized.
3. Reforms should focus on creating a system that produces the optimal workforce of physicians to meet our country’s medical needs. The population of the United States deserves consistent service across the board.
4. Given that the practice of medicine is dynamic and therefore what we need today is not necessarily what we will need in 10 years, the system should be nimble enough to adjust rapidly to the changing medical landscape. Methodologies to project workforce needs will need to be developed and continually refined as data becomes available. This methodology should be used to distribute funding in a way that meets workforce needs, not vested political or financial interests.
5. There must be accountability and transparency built into the system, not only to certify that funds are being spent appropriately to support the training of physicians, but also to ensure quality and the readiness of the physicians emerging from training. A combined governance system with articulated goals and measured outcomes is needed.
6. Programs that produce high-quality graduates in an efficient manner and consistent with workforce needs should be rewarded through financial incentives or higher levels of support. Similarly, funds should be set aside to support innovation in GME, which will incentivize higher quality training.
It is our intent that these principles be used to inform decisions on any proposal affecting how surgeons and other physicians are trained and how such training is financed. The Energy and Commerce Committee is currently reviewing the responses received from ACS and other stakeholders and is expected to use the information received to compose draft reform legislation in the late spring or early summer.
As of yet, neither of the other two committees with jurisdiction over GME reform, (House Ways and Means or Senate Finance), have expressed interest in the topic in the new 114th Congress just underway. However, it is entirely possible such could change if hearings held by the Energy and Commerce Committee generate such interest or if there are broader conversations about Medicare financing in general.
In addition to plans for ACS Division of Advocacy and Health Policy (DAHP) staff to visit and personally present the ACS perspective on GME reform to each member office of the Energy and Commerce Committee, the DAHP is also in the early stages of planning a summit in the Washington office to further explore the topic. The goal would be the development and proposal of innovative solutions designed to improve the way our physician workforce is trained based on our principles listed above.
The topic of GME has long been one of the top priorities for the College and accordingly, this office. Fellows can be assured that the staff of the DAHP recognize such and are diligently directing their efforts into assuring that the surgeon’s perspective is well represented as discussions and deliberations on GME reform get underway on Capitol Hill.
Until next month ...
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy, in the ACS offices in Washington, D.C.