Graduate Medical Education 101
WHAT IS GME?
GME stands for “graduate medical education,” more commonly referred to as ”residency” and “fellowship” training.
The 3 to 9 years of training allows physicians to specialize and practice independently following medical school.
The length of residency depends on the medical specialty; for primary care specialties (family medicine, general pediatrics, general internal medicine), residency training is 3 years.
Protecting funding for this specialty training means that more residents learn to provide the hands-on care patients need, when they need it.
PAYMENT FOR GME
Payment for GME comes from three main sources: patient revenue, Medicare GME payments, and the sponsoring hospital; additionally, residencies in some states receive Medicaid GME and some individual programs receive grant funding.
Patient revenue The amount generated by residencies varies widely, depending on the medical specialty.
Medicare GME payments are provided by the federal government to offset the cost of residency training; the amount of these payments varies widely.
Sponsoring hospital: A third source of payment for GME comes from the hospitals that sponsor residencies. If payments do not equal the costs of GME, the hospital pays for the deficit.
SUMMARY OF CURRENT GME PAYMENT SYSTEM
Was initiated 50 years ago, has been modified periodically.
Is calculated based on complex formulas that include the number of residents in a hospital and the proportion of Medicare inpatient “bed days” in that hospital per year.
Was designed to offset costs to hospitals, where residency training traditionally occurred.
Continues to be most effective for residencies that are hospital-based medical specialties.
Medicare GME Payments can be made only to hospitals, not ambulatory clinics or primary care residencies.
Hospitals that receive GME payments determine the type of residencies they sponsor; a significant portion (21%) of teaching hospitals do not produce any primary care physicians.
There are significant inequities in payments between states and between hospitals, and the formulas that create these inequities do not correlate with the cost of running a residency.
Due to the GME cap, existing residencies do not receive GME payments if they increase the number of training positions.