The Role of GME in Meeting Physician Workforce Needspresentation to:

The Texas Health Care Policy Council and The Texas Medical Association 2008 Stakeholder Forum

Edward SalsbergSenior Associate Vice PresidentDirector, Center for Workforce Studies

April 8, 2008

Aligning GME Policies with Physician Workforce Needs: Overview

1. Identifying, measuring and monitoring workforce needs

• Needs are multi-faceted and no agreement on how to measure

2. Aligning GME policies

• No easy levers

3. Establishing a process and assigning responsibility

Defining Physician Workforce Needs

• Overall supply/numbers

• Geographic distribution

• Specialty distribution

• Competencies

• Diversity

Some possible goals

Increasing the total number of GME positionsTraining in community based settingsTraining in shortage specialtiesInterdisciplinary – team training and careImproved training methods and competenciesEducational innovationsTraining in underserved regionsInfluencing post training practice setting

How to Measure and Project Physician Needs in a State• No single correct number; needs vary based on wide range of

factors such as demographics and disease patterns of population, and extent of poverty

• Can compare to benchmarks such as national average or similar states but very indirect measure of need

• Importance of considering current system and needs and desired system

• For assessing today’s needs can consider from perspective of: providers (hospitals, clinics, health plans: i.e. recruitment

difficulties) practitioners (i.e. waiting times, not taking new patients,

assessment of shortages) patients (i.e. access problems and waiting time)

• For forecasting, critical to assess projected population demographics, utilization patterns and health system

• Recommend a systematic review in the short run and a comprehensive study of needs in the state in the longer run

Decision Makers and Leverage Points

Medical students and residents Medical schools Residency programs Teaching hospitals RRCs Health care delivery system

Methods of Distributing Funds

• As part of reimbursement system or from a central fund

• Standard amount per resident or variable amount based on some criteria

• Grants in response to RFP

• Distribute to teaching hospitals, medical schools, consortia or other organizations

• Limit eligibility, such as to specific areas or specialties

The VA Model for GME Expansion

The Critical Needs/Emerging Specialties RFP

New Affiliations and New Sites of Care RFP

Benefits

• Identify priorities

• Targeting to high need areas and specialties

• Encourage innovation

• Rational process

What about encouraging primary care?

• Needs in both primary care and non-primary care specialties such as those serving the elderly

• Need to improve reimbursement and delivery system

• Currently more primary care GME positions than applicants Need to encourage more applicants Reimbursement policies Loan repayment Supportive grants to assist rural sites

• Education and training with teams of PAs, NPs and others

Closing Thoughts

• Establish a systematic process to identify physician needs on an on-going basis

• Encourage flexibility to support training in the most appropriate setting

• Support for federal legislation to lift or modify the cap on Medicare GME

• Set aside some GME funds to be distributed via RFP to encourage new initiatives: Interdisciplinary teamsEstablishment of programs in specialties with

shortages in regions of the stateInnovations in education