United States Senate
WASHINGTON, DC 20510
December 21, 2011
Harvey Fineberg, MD, PhD
President
Institute of Medicine
500 Fifth Street, NW
Washington, DC 20001
Dear Dr. Fineberg:
We are writing to encourage the Institute of Medicine (IOM) to conduct an independent review of the governance and financing of our system of graduate medical education (GME). The IOM’s influential 2001 report Crossing the Quality Chasm: A New Health System for the 21st Century recommended a summit to discuss reforming health professions education, which was held in 2002 and attended by 150 important organizations. Earlier, the IOM had convened a public hearing in 1997 to solicit views on GME from various stakeholders, including physician, nursing, hospital and medical college professional associations.
Much has happened since these events. We believe our GME system is under increasing stress, and the projections for our health care workforce are of significant concern. There is growing concern that the United States is failing to adequately match medical training with our medical needs on a national level. Changes to GME are being discussed by Congress, the Medicare Payment Advisory Commission, Accreditation Council for Graduate Medical Education, and various foundations, such as the Josiah Jr. Macy Foundation. It is time to redesign health care workforce education and training in a manner that improves access to and delivery of health care services and enables the future generation of health care professionals to actively participate in creating high quality, lower cost health care.
Specifically, we are interested in an analysis of the governance and financing of GME and potential GME reforms. Some areas deserving of particular attention are: accreditation; reimbursement policy; using GME to better predict and assure adequate workforce supply by type of provider, specialty, and demographic mix; distribution of physicians; the role of GME in the current care of the underserved; the impact of changes in GME on access to health care; and use of GME to assure a future workforce possessing the skill set to effectively address current and future health care needs. In addition, we are particularly interested in IOM’s observations about the uneven distribution of GME funding across states based on need and capacity, and how to address this inequity.
We urge the IOM to move forward immediately with additional public and private sponsors to empanel a consensus committee to develop recommendations to meet the challenges
facing GME. We would hope 10 have recommendations from the IOM regarding suggested statutory, regulatory and accreditation changes by the third quarter of 2012. Thank you for your attention to this matter.
Sincerely.
United States Senate
WASHINGTON, DC 20510
June 20, 2012
Dear Dr. Fineberg:
As the Institute of Medicine (IOM) prepares for its study of graduate medical education (GME) and the U.S. health workforce, we write to urge you to examine all of the federal programs that help educate and train our health care workforce.
Last year you heard from some of our Senate colleagues explaining that our GME system is under increasing stress and expressing concern that the policy discussion of GME is not always grounded in facts and data. That is why we welcome the IOM’s study – GME is too important to our nation’s health system to change without a comprehensive examination.
As the IOM investigates options that better align GME and physician and other health provider supply with the nation’s future health care needs, we strongly urge you to review a broad range of health workforce education and training programs, not just those funded through Medicare. Indeed, MedPAC in its June 2010 Report to Congress said, “Federal programs other than Medicare could also contribute to improving the output of the GME system as well as to the development of other important health professionals.”
For example, the Health Resources and Services Administration (HRSA) has a number of programs designed to develop the health care workforce and promote access to primary care, including: Children’s Graduate Medical Education (CHGME) program, Titles VII Health Professions programs, Title VIII Nursing Education programs, the new Teaching Health Center (THC) Program. In the same vein, we ask that the IOM review the current definition of Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas (MUAs) and determine if those designations could be more comprehensive or assist in questions of workforce distribution.
Second, we ask that the IOM conduct a comprehensive examination of how GME relates to ultimate physician practice location and physician mal-distribution. We believe that it is important to look beyond the number of training positions in each state to understand and address the factors influencing a physician’s practice location. A recent analysis of physician workforce data appears to indicate that, in fact, the distribution of GME positions across the nation may actually have little or no impact on the geographic distribution of physicians. Medicaid reimbursement levels, employment opportunities for spouses and cost of living may be driving a physician’s decision about where to practice.
In addition, over the years, we have all supported efforts to increase the number of GME medical residency slots. We hope that the IOM will also examine the statutory cap on these slots.
Finally, we believe it is also critical to examine the impact of Medicaid GME funding reductions in recent years on health care workforce education and training.
Thank you for your consideration of this request.
Sincerely,