Texas Gme Salsberg 4 8 08v4


Published on

From TMA GME Stakeholder Forum

Published in: Health & Medicine, Career
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • © 2006 Association of American Medical Colleges.
  • Texas Gme Salsberg 4 8 08v4

    1. 1. Edward Salsberg Senior Associate Vice President Director, Center for Workforce Studies April 8, 2008 The Role of GME in Meeting Physician Workforce Needs presentation to: The Texas Health Care Policy Council and The Texas Medical Association 2008 Stakeholder Forum
    2. 2. Aligning GME Policies with Physician Workforce Needs: Overview <ul><li>Identifying, measuring and monitoring workforce needs </li></ul><ul><ul><li>Needs are multi-faceted and no agreement on how to measure </li></ul></ul><ul><li>Aligning GME policies </li></ul><ul><ul><li>No easy levers </li></ul></ul><ul><li>Establishing a process and assigning responsibility </li></ul>
    3. 3. Defining Physician Workforce Needs <ul><ul><li>Overall supply/numbers </li></ul></ul><ul><ul><li>Geographic distribution </li></ul></ul><ul><ul><li>Specialty distribution </li></ul></ul><ul><ul><li>Competencies </li></ul></ul><ul><ul><li>Diversity </li></ul></ul>
    4. 4. Some possible goals <ul><ul><li>Increasing the total number of GME positions </li></ul></ul><ul><ul><li>Training in community based settings </li></ul></ul><ul><ul><li>Training in shortage specialties </li></ul></ul><ul><ul><li>Interdisciplinary – team training and care </li></ul></ul><ul><ul><li>Improved training methods and competencies </li></ul></ul><ul><ul><li>Educational innovations </li></ul></ul><ul><ul><li>Training in underserved regions </li></ul></ul><ul><ul><li>Influencing post training practice setting </li></ul></ul>
    5. 5. How to Measure and Project Physician Needs in a State <ul><ul><li>No single correct number; needs vary based on wide range of factors such as demographics and disease patterns of population, and extent of poverty </li></ul></ul><ul><ul><li>Can compare to benchmarks such as national average or similar states but very indirect measure of need </li></ul></ul><ul><ul><li>Importance of considering current system and needs and desired system </li></ul></ul><ul><ul><li>For assessing today’s needs can consider from perspective of: </li></ul></ul><ul><ul><ul><li>providers (hospitals, clinics, health plans: i.e. recruitment difficulties) </li></ul></ul></ul><ul><ul><ul><li>practitioners (i.e. waiting times, not taking new patients, assessment of shortages) </li></ul></ul></ul><ul><ul><ul><li>patients (i.e. access problems and waiting time) </li></ul></ul></ul><ul><ul><li>For forecasting, critical to assess projected population demographics, utilization patterns and health system </li></ul></ul><ul><ul><li>Recommend a systematic review in the short run and a comprehensive study of needs in the state in the longer run </li></ul></ul>
    6. 6. Decision Makers and Leverage Points <ul><ul><ul><li>Medical students and residents </li></ul></ul></ul><ul><ul><ul><li>Medical schools </li></ul></ul></ul><ul><ul><ul><li>Residency programs </li></ul></ul></ul><ul><ul><ul><li>Teaching hospitals </li></ul></ul></ul><ul><ul><ul><li>RRCs </li></ul></ul></ul><ul><ul><ul><li>Health care delivery system </li></ul></ul></ul>
    7. 7. Methods of Distributing Funds <ul><ul><li>As part of reimbursement system or from a central fund </li></ul></ul><ul><ul><li>Standard amount per resident or variable amount based on some criteria </li></ul></ul><ul><ul><li>Grants in response to RFP </li></ul></ul><ul><ul><li>Distribute to teaching hospitals, medical schools, consortia or other organizations </li></ul></ul><ul><ul><li>Limit eligibility, such as to specific areas or specialties </li></ul></ul>
    8. 8. The VA Model for GME Expansion <ul><li>The Critical Needs/Emerging Specialties RFP </li></ul><ul><li>New Affiliations and New Sites of Care RFP </li></ul><ul><li>Benefits </li></ul><ul><ul><li>Identify priorities </li></ul></ul><ul><ul><li>Targeting to high need areas and specialties </li></ul></ul><ul><ul><li>Encourage innovation </li></ul></ul><ul><ul><li>Rational process </li></ul></ul>
    9. 9. What about encouraging primary care? <ul><ul><li>Needs in both primary care and non-primary care specialties such as those serving the elderly </li></ul></ul><ul><ul><li>Need to improve reimbursement and delivery system </li></ul></ul><ul><ul><li>Currently more primary care GME positions than applicants </li></ul></ul><ul><ul><ul><li>Need to encourage more applicants </li></ul></ul></ul><ul><ul><ul><li>Reimbursement policies </li></ul></ul></ul><ul><ul><ul><li>Loan repayment </li></ul></ul></ul><ul><ul><ul><li>Supportive grants to assist rural sites </li></ul></ul></ul><ul><ul><li>Education and training with teams of PAs, NPs and others </li></ul></ul>
    10. 10. Closing Thoughts <ul><ul><li>Establish a systematic process to identify physician needs on an on-going basis </li></ul></ul><ul><ul><li>Encourage flexibility to support training in the most appropriate setting </li></ul></ul><ul><ul><li>Support for federal legislation to lift or modify the cap on Medicare GME </li></ul></ul><ul><ul><li>Set aside some GME funds to be distributed via RFP to encourage new initiatives: </li></ul></ul><ul><ul><ul><li>Interdisciplinary teams </li></ul></ul></ul><ul><ul><ul><li>Establishment of programs in specialties with shortages in regions of the state </li></ul></ul></ul><ul><ul><ul><li>Innovations in education </li></ul></ul></ul>