Texas Gme Salsberg 4 8 08v4
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Texas Gme Salsberg 4 8 08v4



From TMA GME Stakeholder Forum

From TMA GME Stakeholder Forum



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  • © 2006 Association of American Medical Colleges.

Texas Gme Salsberg 4 8 08v4 Texas Gme Salsberg 4 8 08v4 Presentation Transcript

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