'Graduate Medical Education That Meets the Nation's Health Needs'
David A. Fleming, MD, MA, FACP
President of the American College of Physicians (ACP)
July 31, 2014
(Washington) - The American College of Physicians (ACP) appreciates the Institute of Medicine (IOM) efforts to review the governance and financing of graduate medical education (GME). It agrees that the nation's investment in GME should be used to train physicians with the right numbers, mix, and distribution of specialties and practice location and skills needed to meet the nation's healthcare workforce needs. We applaud the IOM for its emphasis on innovation, transformation and accountability.
ACP is very concerned, however, that the IOM did not make recommendations that address the nation's looming physician workforce crisis. We are particularly concerned that the IOM stated that it "did not find credible evidence" to support claims that the nation is facing a looming physician shortage, particularly in primary care specialties. Paradoxically, the IOM also suggested that "GME funds might be used to finance new incentives for choosing a primary care career," even as it questioned whether a primary care shortage exists. Although we concur with the IOM that more research is needed to guide physician workforce policies and that incentives, including payment reform, are needed to encourage careers in primary care, we believe there is credible evidence of a real and growing shortage of primary care physicians for adults warranting immediate action. It is estimated by highly credible analyses that the nation will need 44,000 - 46,000 additional primary care physicians by 2025. This figure does not take into account the increasing demand for primary care services as an estimated 25 million uninsured Americans will obtain coverage through the reforms in the Affordable Care Act. There is also solid evidence that access to primary care is associated with better outcomes and lower cost of care.
In order to reform the nation's health care delivery system to better manage chronic conditions and keep patients from requiring hospitalization, an adequate supply of primary care physicians who can function with specialists and other health professionals as part of a team to manage a patient's whole health will be critical. ACP supports strategic increases in the number of Medicare-funded GME positions in primary care and other specialties facing shortages including many internal medicine subspecialties.
ACP agrees with the IOM that GME is a public good- it benefits all of society, not just those who directly purchase or receive it. We are disappointed that the IOM did not call for an all-payer GME financing system to support this public good.
ACP joins with the IOM in its call for innovation and transformation in GME, including a greater emphasis on training in community-based settings, but we are very concerned that reducing GME payments to existing programs to fund innovation and transformation could do great harm to the educational mission of many teaching hospitals and the patients they serve.
We also agree with the IOM that it is critical that GME policy be aligned with the nation's workforce policies. Millions of Americans do not have adequate access to health care services, physicians are not optimally distributed among specialties or geographically, and numerous studies warn of an impending physician shortage.
ACP will be reviewing the IOM report in greater detail, offering our suggestions in the spirit of building upon the many imaginative reforms recommended in the report. We will also continue to advocate for policies to ensure an adequate supply of physicians to meet the nation's health care needs, including strategic increases in the number of Medicare-funded GME positions in primary care and other specialties facing shortages.
The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 141,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.