The Potential Impact of Reduction in Federal GME Funding in the United States: A Study of the Estimates of Designated Institutional Officials

Abstract

As a result of the decisions made in the Summer of 2011 to increase the federal debt limit of the United States,1 the Joint Select Committee on Deficit Reduction (the “Super Committee”) was formed to recommend to the Congress by 12 2011 reductions in federal spending to be accomplished over the next 10 years. Among the entitlement program elements being examined by the Super Committee, Medicare reimbursement for Graduate Medical Education (GME), the primary source of GME funding in the United States, has been identified as an opportunity for spending reductions. Specifically, the Medicare Payment Advisory Commission (MedPAC) has indicated that approximately 50% of the Indirect GME Reimbursement is not “empirically justified” on the basis of current costs of teaching hospitals intended to be covered by that reimbursement.2 This is seen by many as an opportunity for reduction. Furthermore, the Simpson Bowles Commission recommended a reduction in total GME funding in excess of 50% ($60 billion over 10 years) as a component of a comprehensive strategy to reduce federal deficit spending.3 This discussion occurs in the context of a predicted physician shortage, a mounting surge in the number of domestic graduates of schools of allopathic and osteopathic medicine designed to remedy that anticipated physician shortage,4 and slow growth in GME output over the past decade.5 However, this increase in medical school output must be accompanied by an increase in Graduate Medical Education, which is the required final pathway to entry into the unsupervised practice of medicine in the United States. As the body charged by the public and the profession with accreditation oversight of the vast majority of the GME programs in the United States, and to measure the quality of educational opportunities for physicians as they seek to prepare to meet the needs of the American public, the Accreditation Council for Graduate Medical Education (ACGME) attempted to estimate the impact of reductions in GME funding of the magnitude under discussion in our nation's capital on the educational pipeline for physicians.