- HHS needs more information about graduate medical education (GME) to better assess GME enrollment, the national clinician shortage, and patient care access, according to a recent report from the Government Accountability Office (GAO).
Graduate medical education, commonly referred to was residency, follows medical school and gives aspiring physicians practical medical experience. Numerous government agencies help pay from GME programs across the country, GAO explained.
In total, federal and state Medicaid agencies spent over $16 billion to fund GME programs in 2015. The federal government provided $14.5 billion through five various programs, and a total of 45 state Medicaid agencies covered $1.8 billion. These funds aided about half of GME teaching sites, including teaching hospitals, GAO reported.
Most of these programs collect information about their respective GME funding programs, GAO said, but there is little uniformity.
“While federal agencies generally collect information needed to manage their individual programs, this information is not sufficient to comprehensively understand whether the federal investment in GME training meets national physician workforce needs,” the report noted. “The information agencies collect is not always complete or consistent within or across programs.”
According to GAO, there is little consistency about GME training through different federal programs, which exacerbates the data collection issue GAO observed. Training yields different costs depending on teaching sites, the number of residents, and resident specialty. There are also some costs that are difficult to quantify, such as the cost of faculty teaching time.
Because of those difficulties, there is very little information about GME enrollment.
Specifically, there is not enough data about:
- How much it costs to train physicians
- How much the government spends
- What the government gets for its money
Limited GME information makes it difficult for GME leaders and federal agencies to target enrollment efforts and address clinician shortage issues.
“An adequate, well-trained physician workforce is essential for providing access to quality health care,” GAO explained. “While a number of factors affect the supply and distribution of physicians, GME is a significant determinant.”
The nation is currently experiencing a significant physician shortage. Dental health, primary care, and mental health specialties are currently suffering the worst from the physician shortage, according to statistics from the Health Resources & Services Administration.
In its 2017 projections for national provider shortages, the Association of American Medical Colleges (AAMC) predicted that the US will face a physician shortage between 40,800 and 104,900 by 2030. For primary care, the estimated shortage will be between 8,700 and 43,100 physicians by 2030.
Significant physician shortages create patient access to care issues. A simple supply and demand issue, this means that when there are not enough physicians to go around patients face long wait times or even the total inability to see a doctor for some medical needs.
Previously, GAO recommended HHS collect data about the physician shortage and to create a plan for addressing workforce shortages in certain areas. However, some logistical barriers make it so HHS cannot move further in those plans.
“While HHS has yet to take these steps, the information currently available is also insufficient for such planning,” the current GAO report noted. “Comprehensive information is needed to identify gaps between federal GME programs and national physician workforce needs— particularly the distribution of physicians geographically or across specialties— and to make or recommend to Congress changes to improve the efficient and effective use of federal funds to meet those needs.”
Creating targeted GME plans can help reduce the physician shortage and support more equal patient access to care. Federal programs can ramp up their efforts in individual regions or within certain specialties. However, comprehensive and consistent data is necessary to accomplish that.
GAO offered two primary recommendations for HHS.
First, HHS must coordinate with other federal bodies that help fund graduate medical education. Such agencies include the VA. These agencies must assess the performance of funding programs and the efficiency at which the programs meet the needs for graduate medical education.
Second, HHS must coordinate with federal agencies about better ways to collect data about graduate medical education funding and efficiency. They need to establish a plan for consistency of information and then implement those plans.
GAO also recently tackled the issue of GME within the Department of Defense. A March, 2018 GAO report stated that the DoD must better target its GME recruitment to enroll more residents to its GME programs. In doing so, DoD may supplement its overall physician recruitment efforts and avert a patient access to care issue within the department.