Aligning Expansion of Graduate Medical Education With Recent Recommendations for Reform
Authors: Richard E. Rieselbach, Paul H. Rockey, Robert L. Phillips Jr., Kathleen Klink, Malcolm Cox
Journal: Annals of Internal Medicine (2014)

Ideas and Opinions4 November 2014Aligning Expansion of Graduate Medical Education With Recent Recommendations for ReformRichard E. Rieselbach, MD, Paul H. Rockey, MD, MPH, Robert L. Phillips Jr., MD, MSPH, Kathleen Klink, MD, and Malcolm Cox, MDRichard E. Rieselbach, MDFrom University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Southern Illinois University School of Medicine, Springfield, Illinois; American Board of Family Medicine, Lexington, Kentucky; Georgetown University and Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC; Virginia Commonwealth University, Richmond, Virginia;and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.Search for more papers by this author, Paul H. Rockey, MD, MPHFrom University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Southern Illinois University School of Medicine, Springfield, Illinois; American Board of Family Medicine, Lexington, Kentucky; Georgetown University and Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC; Virginia Commonwealth University, Richmond, Virginia;and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.Search for more papers by this author, Robert L. Phillips Jr., MD, MSPHFrom University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Southern Illinois University School of Medicine, Springfield, Illinois; American Board of Family Medicine, Lexington, Kentucky; Georgetown University and Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC; Virginia Commonwealth University, Richmond, Virginia;and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.Search for more papers by this author, Kathleen Klink, MDFrom University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Southern Illinois University School of Medicine, Springfield, Illinois; American Board of Family Medicine, Lexington, Kentucky; Georgetown University and Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC; Virginia Commonwealth University, Richmond, Virginia;and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.Search for more papers by this author, and Malcolm Cox, MDFrom University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Southern Illinois University School of Medicine, Springfield, Illinois; American Board of Family Medicine, Lexington, Kentucky; Georgetown University and Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC; Virginia Commonwealth University, Richmond, Virginia;and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-1838 Annals Author Insight Video - Paul H. Rockey, MD, MPH In this video, Paul H. Rockey, MD, MPH, offers additional insight into his Ideas and Opinions piece, "Aligning Expansion of Graduate Medical Education With Recent Recommendations for Reform." SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Federal funds totaling $16 billion support 120 000 graduate medical education (GME) positions (1). However, too few physicians are trained to practice high-quality primary care that can improve outcomes and decrease costs (2). Consistent with recommendations of the Institute of Medicine's (IOM) recent review of the governance and financing of GME (3), we propose using existing funds to expand primary care positions that target urban and rural areas with shortages of health professionals. We also propose using recently approved Veterans Affairs (VA) funding to expand primary care and mental health residency positions that target VA clinical sites that need more health ...References1. Chandra A, Khullar D, Wilensky GR. The economics of graduate medical education. N Engl J Med. 2014;370:2357-60. [PMID: 24826947] doi:10.1056/NEJMp1402468 CrossrefMedlineGoogle Scholar2. Voorhees KI, Prado-Gutierrez A, Epperly T, Dirkson D. A proposal for reform of the structure and financing of primary care graduate medical education. Fam Med. 2013;45:164-70. [PMID: 23463428] MedlineGoogle Scholar3. Graduate Medical Education That Meets the Nation's Health Needs. Washington, DC: Institute of Medicine; 29 July 2014. Accessed at www.iom.edu/Reports/2014/Graduate-Medical-Education-That-Meets-the-Nations-Health-Needs.aspx on 9 September 2014. Google Scholar4. Chen C, Chen F, Mullan F. Teaching health centers: a new paradigm in graduate medical education. Acad Med. 2012;87:1752-6. [PMID: 23095929] doi:10.1097/ACM.0b013e3182720f4d CrossrefMedlineGoogle Scholar5. Rieselbach RE, Crouse BJ, Neuhausen K, Nasca TJ, Frohna JG. Academic medicine: a key partner in strengthening the primary care infrastructure via teaching health centers. Acad Med. 2013;88:1835-43. [PMID: 24128617] doi:10.1097/ACM.0000000000000035 CrossrefMedlineGoogle Scholar6. Rieselbach RE, Crouse BJ, Frohna JG. Teaching primary care in community health centers: addressing the workforce crisis for the underserved. Ann Intern Med. 2010;152:118-22. [PMID: 20008743] doi:10.7326/0003-4819-152-2-201001190-00186 LinkGoogle Scholar7. Phillips RL, Petterson S, Bazemore A. Do residents who train in safety net settings return for practice? Acad Med. 2013;88:1934-40. [PMID: 24128640] doi:10.1097/ACM.0000000000000025 CrossrefMedlineGoogle Scholar8. Rieselbach RE, Phillips RL, Nasca TJ, Crouse BJ. Rural primary care physician workforce expansion: an opportunity for bipartisan legislation. J Grad Med Educ. 2013;5:556-9. [PMID: 24455000] doi:10.4300/JGME-05-04-39 CrossrefMedlineGoogle Scholar9. Gilman SC, Chokshi DA, Bowen JL, Rugen KW, Cox M. Connecting the dots: interprofessional health education and delivery system redesign at the veterans health administration. Acad Med. 2014;89:1113-6. [PMID: 24853198] doi:10.1097/ACM.0000000000000312 CrossrefMedlineGoogle Scholar10. The Veterans Access, Choice, and Accountability Act of 2014, HR 3230, 113th Cong (2013–2014). Google Scholar Author, Article, and Disclosure InformationAffiliations: From University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Southern Illinois University School of Medicine, Springfield, Illinois; American Board of Family Medicine, Lexington, Kentucky; Georgetown University and Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC; Virginia Commonwealth University, Richmond, Virginia;and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.Disclaimer: Dr. Rieselbach is Past President of the Association of Program Directors in Internal Medicine, and Dr. Rockey is a Scholar in Residence at the Accreditation Council for Graduate Medical Education and the Past Director of the Division of Graduate Medical Education at the American Medical Association. Dr. Phillips is the Vice President for Research and Policy for the American Board of Family Medicine, and Dr. Klink is Medical Director at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care and Immediate Past Director of the Health Resources and Services Administration's Division of Medicine and Dentistry at the Bureau of Health Professions. Dr. Cox is the Immediate Past Chief Academic Affiliations Officer at the Veterans Health Administration. This proposal does not necessarily reflect the position of any of these organizations.Acknowledgment: The authors thank Drs. Karen Sanders, David Sundwall, and Thomas Nasca for their suggestions and contributions. They also thank Ms. Kathy Holland for her invaluable assistance in preparing the manuscript.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1838.Corresponding Author: Richard E. Rieselbach, MD, Professor Emeritus, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 7974 UW Health Court, Middleton, WI 53562; e-mail, [email protected]wisc.edu.Current Author Addresses:Dr. Rieselbach: Professor Emeritus, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 7974 UW Health Court, Middleton, WI 53562.Dr. Rockey: Accreditation Council for Graduate Medical Education, 515 North State Street, Suite 2000, Chicago, IL 60654.Drs. Phillips and Klink: American Board of Family Medicine, 1133 Connecticut Avenue Northwest, Suite 1100, Washington, DC 20036.Dr. Cox: 121 Overlook Drive, Media, PA 19063.Author Contributions:Conception and design: R.E. Rieselbach,P.H. Rockey, R.L. Phillips, K. Klink, M. Cox.Analysis and interpretation of the data: R.E. Rieselbach, P.H. Rockey, R.L. Phillips, K. Klink, M. Cox.Drafting of the article: R.E. Rieselbach, P.H. Rockey, R.L. Phillips, K. Klink, M. Cox.Critical revision of the article for important intellectual content:R.E. Rieselbach, P.H. Rockey, R.L. Phillips, K. Klink, M. Cox.Final approval of the article: R.E. Rieselbach, P.H. Rockey, R.L. Phillips, K. Klink, M. Cox.Administrative, technical, or logistic support: R.E. Rieselbach, P.H. Rockey, R.L. Phillips, K. Klink, M. Cox.Collection and assembly of data: R.E. Rieselbach, P.H. Rockey, R.L. Phillips, K. Klink, M. Cox. PreviousarticleNextarticle Advertisement Annals Author Insight Video - Paul H. Rockey, MD, MPH In this video, Paul H. Rockey, MD, MPH, offers additional insight into his Ideas and Opinions piece, "Aligning Expansion of Graduate Medical Education With Recent Recommendations for Reform." FiguresReferencesRelatedDetails Metrics Cited ByCommunity Health Centers Could Provide Better Outsourced Primary Care for VeteransWorld medical schools: The sum also risesCharacteristics and Distribution of Graduate Medical Education Training SitesHomegrown = Home-Served: The Power of Local Training 4 November 2014Volume 161, Issue 9Page: 668-669KeywordsGraduate medical educationHealth careHealth care facilitiesMedical servicesMedicarePrevention, policy, and public healthPsychiatry and mental healthResidencyRural areasVeteran care ePublished: 4 November 2014 Issue Published: 4 November 2014 CopyrightCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...