Nicole V. Baptista
The Alliance for Academic Internal Medicine (AAIM) wrote a letter to the Medicare Payment Advisory Commission (MedPAC) September 16, 2009, in response to the commission's June 2009 report to Congress and its findings that internal medicine residency programs are not successfully training residents for practice in the 21st century.
AAIM’s letter provides input to MedPAC as the commission prepares to consider recommendations relating to workforce, graduate medical education (GME) “pay-for” systems, and all-payer funding. Overall, AAIM recommends MedPAC does not use GME funding as a blunt tool to incite change in residency training. Instead, MedPAC should consider the most effective role for Medicare in addressing any issues in GME, including current workforce needs. Moreover, the commission should not increase the regulatory and financial burden on training programs. In addition, AAIM recommends MedPAC includes the academic internal medicine community in any discussions about the future of Medicare funding for GME.
In its letter, AAIM also critiqued the flawed design, conduct, and analysis of the RAND Corporation study that informed MedPAC’s discussion on GME. More importantly, AAIM provided insight on current methods for teaching the competencies reviewed in the RAND report, barriers to formal curricular changes, and efforts underway by the academic internal medicine community to ensure training is meeting the needs of the 21st century.
MedPAC’s chapter on graduate medical education was informed by the RAND Corporation study, “How Are Residency Programs Preparing Our 21st Century Internists? A Review of Internal Medicine Residency Programs’ Teaching on Selected Topics.” MedPAC commissioned the RAND study, which found curricula for internal medicine residency programs overall lack formal training and experience in outpatient care coordination, multidisciplinary team work, awareness of health care costs, comprehensive health information technology, and patient care in non-hospital settings. Unfortunately, the RAND report had significant flaws. The MedPAC discussion further highlighted the flaws of the RAND report as it did not consider the efforts that teaching hospitals and residency programs have already taken to enhance GME training and the challenges internal medicine residency training programs face.
During MedPAC’s public meeting September 17-18, 2009, Council on Graduate Medical Education (COGME) Chair Russell G. Robertson, MD, presented COGME’s perspective on medical education issues. Dr. Russell discussed the growth in hospitals’ specialty fellowship positions as well as the strong correlation between competitive specialties and higher physician income. Dr. Russell highlighted COGME’s recommendations to increase the flexibility of GME and create a fund that pools federal and all payer funding to support GME.
MedPAC will continue to consider the number and specialty mix of trainees and will address physician workforce issues in its March 2010 report to Congress.