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Fitzhugh Mullan, MD
Murdock Head Professor of
Medicine and Health Policy
George Washington University
Number of MD and DO Medical School
Graduates from 1970 - 2013
Year
NumberofGraduates
0
5000
10000
15000
20000
25000
MD DO ...
Academic Year MD Graduates DO Graduates Total Graduates
1980-1981 15,632 1,151 16,783
1990-1991 15,427 1,534 16,961
2000-2...
1st Year MD and DO Enrollment In
2003 Compared With Projected 2017
Enrollment Figures
2003 2017 # and % Increase
MD 16,541...
Graduates and Projected Number of US
MD and DO Graduates from 2008-2021
0
5000
10000
15000
20000
25000
30000
MD DO Total
N...
Academic
Graduation Year
MD Graduates DO Graduates Total Graduates
2008-2009 16,467 3,588 20,055
2009-2010 16,836 3,631 20...
New Entrants into GME: Entrants into
GME Without Prior GME 2010-2013
Sources: NCHWA analysis of data from AAMC and AACOM, ...
Projected US MD and DO Medical School
Graduates (with 3% Attrition Rate) and 1st
Year Entrants into GME (2009-2021)
Year
2...
Match
Year
1st Year Entrants
into GME
US MD and DO
Medical School
Graduates
(3% Attrition Rate)
Difference
2009 27,198 20,...
Teaching Health Centers
and THCGME
White K. et al, The Ecology of Medical Care, NEJM, 1961
L. Green et al., The Ecology of Medical Care Revisited, NEJM, 2001
• GME History
• Teaching in Health Centers
• The ACA opportunity
• Section 5508 of the ACA established the
Teaching Health...
• The program is funded at $230 million from
FY2011 to FY2015, a five year initiative.
• Administered by the Health Resour...
• There are 44 THCs in 21 states across the
country.
– 3 states (Colorado, Florida and Tennessee) will be
added in the 201...
THC Residency Numbers
2011 2012 2013
Number of THC
Programs
11 22 44
PGY-1 THC
Residents
44 154 273
# of residents
per yea...
Specialty Number of THCs
Dental 2
Family Medicine 29
Internal Medicine 5
OB/GYN 2
Pediatrics 3
Psychiatry 3
THC Residency ...
THC Accreditation
THC Year ACGME AOA ACGME/AOA CODA N/A
2011 5 1 4 1 0
2012 0 9 1 1 0
2013 8 11 2 0 1
Total 13 21 7 2 1
• GW was awarded the Evaluation and Initial
Assessment of HRSA Teaching Health Centers
contract.
• This is a five year con...
• THC funding will end in 2015.
• THC classes that began in July 2013 do not have
funding for the last 9 months of their t...
• On November 23, 2013 Senator Bernie Sanders (I-VT)
introduced Senate Bill 1759, Teaching Health Center
Reauthorization A...
• The President’s FY 2015 Budget increases
funding for primary care residency positions.
• THCGME program is not specifica...
THCs are:
• Dedicated primary care education centers
• De-institutionalized medical training
• A means of increasing resid...
Tectonic Plates of GME- Fitzhugh Mullan
Tectonic Plates of GME- Fitzhugh Mullan
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Tectonic Plates of GME- Fitzhugh Mullan

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This presentation was given at FMCC on April 7, 2014 as part of a panel on Workforce Development. The session focused on thr innovative Teaching Health Center program which supports family medicine training.

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Tectonic Plates of GME- Fitzhugh Mullan

  1. 1. Fitzhugh Mullan, MD Murdock Head Professor of Medicine and Health Policy George Washington University
  2. 2. Number of MD and DO Medical School Graduates from 1970 - 2013 Year NumberofGraduates 0 5000 10000 15000 20000 25000 MD DO Total
  3. 3. Academic Year MD Graduates DO Graduates Total Graduates 1980-1981 15,632 1,151 16,783 1990-1991 15,427 1,534 16,961 2000-2001 15,796 2,510 18,306 2001-2002 15,676 2,536 18,212 2002-2003 15,531 2,607 18,138 2003-2004 15,829 2,713 18,542 2004-2005 15,760 2,756 18,516 2005-2006 15,927 2,708 18,635 2006-2007 16,140 3,000 19,140 2007-2008 16,168 3,364 19,532 2008-2009 16,467 3,588 20,055 2009-2010 16,836 3,631 20,467 2010-2011 17,362 4,159 21,521 2011-2012 17,343 4,458 21,801 2012-2013 18,156 4,726 22,882 Number of MD and DO Medical School Graduates from 1980 - 2013 Sources: AAMC and ACCOM
  4. 4. 1st Year MD and DO Enrollment In 2003 Compared With Projected 2017 Enrollment Figures 2003 2017 # and % Increase MD 16,541 21,434 4,893 29.6% DO 3,308 6,675 3,367 101.8% _______________________________________________ Combined 19,849 28,109 8,260 41.2% Sources: AAMC Results of the 2012 Medical School Enrollment Survey, May 2013; AAMC Enrollment Data 2008 https://www.aamc.org/download/60740/data/enrollmentdata2008.pdf AACOM – Trends in Osteopathic Medical School Applicants, Enrollment and Graduates
  5. 5. Graduates and Projected Number of US MD and DO Graduates from 2008-2021 0 5000 10000 15000 20000 25000 30000 MD DO Total NumberofGraduates Year | Extrapolated | | Projected |
  6. 6. Academic Graduation Year MD Graduates DO Graduates Total Graduates 2008-2009 16,467 3,588 20,055 2009-2010 16,836 3,631 20,467 2010-2011 17,362 4,159 21,521 2011-2012 17,343 4,458 21,801 2012-2013 18,156 4,726 22,882 2013-2014* 18,665 5,428 24,093 2014-2015* 19,230 5,788 25,018 2015-2016* 19,517 5,986 25,503 2016-2017* 20,055 6,449 26,504 2017-2018** 20,654 6271 26,925 2018-2019** 21,053 6,222 27,275 2019-2020** 21,255 6,179 27,434 2020-2021** 21,434 6,675 28,109 MD and DO Medical School Graduation Projections from 2008 - 2021 Sources: AAMC and ACCOM *Notes extrapolated data **Notes projected data
  7. 7. New Entrants into GME: Entrants into GME Without Prior GME 2010-2013 Sources: NCHWA analysis of data from AAMC and AACOM, April 2012; Number for 2011 is provisional; Number for 2013 is from NRMP and AOA 25,105 25,151 25,384 25,617 25,574 25,959 26,084 26,220 26,692 27,198 27,489 28,450 28,871 29,292 20,000 21,000 22,000 23,000 24,000 25,000 26,000 27,000 28,000 29,000 30,000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Entrants Year
  8. 8. Projected US MD and DO Medical School Graduates (with 3% Attrition Rate) and 1st Year Entrants into GME (2009-2021) Year 2014-2021 data are based on a 1% annual increase in entrants into GME 15,000 17,000 19,000 21,000 23,000 25,000 27,000 29,000 31,000 33,000 2009 2010 2011 2012 2013 2014* 2015* 2016* 2017* 2018** 2019** 2020** 2021** 1st Year Entrants into GME US Medical School Graduates with 3% Attrition Rate
  9. 9. Match Year 1st Year Entrants into GME US MD and DO Medical School Graduates (3% Attrition Rate) Difference 2009 27,198 20,055 7,143 2010 27,489 20,467 7,022 2011 28,450 21,521 6,929 2012 28,871 21,801 7,070 2013 29,292 22,882 6,410 2014* 29,585 23,370 6,215 2015* 29,881 24,267 5,613 2016* 30,180 24,738 5,442 2017* 30,481 25,709 4,772 2018** 30,786 26,117 4,669 2019** 31,094 26,457 4,637 2020** 31,405 26,611 4,794 2021** 31,719 27,266 4,453 Projected US MD and DO Medical School Graduates (with 3% Attrition Rate) and 1st Year Entrants into GME (2009-2021) *Notes extrapolated data **Notes projected data 2014-2021 data are based on a 1% annual increase in entrants into GME
  10. 10. Teaching Health Centers and THCGME
  11. 11. White K. et al, The Ecology of Medical Care, NEJM, 1961
  12. 12. L. Green et al., The Ecology of Medical Care Revisited, NEJM, 2001
  13. 13. • GME History • Teaching in Health Centers • The ACA opportunity • Section 5508 of the ACA established the Teaching Health Center Graduate Medical Education (THCGME) program Teaching Health Centers
  14. 14. • The program is funded at $230 million from FY2011 to FY2015, a five year initiative. • Administered by the Health Resources and Services Administration (HRSA). • Under the jurisdiction of the Senate Health Education Labor and Pension (HELP) Committee, and the House Energy and Commerce Committee. THCGME Program
  15. 15. • There are 44 THCs in 21 states across the country. – 3 states (Colorado, Florida and Tennessee) will be added in the 2014 THC cohort. • THCs are located in underserved communities in rural and inner city areas. • Each year new THCs are added to the program. – In 2011 - 11 total THCs – In 2012 - 22 total THCs – In 2013 - 44 total THCs Current THCs
  16. 16. THC Residency Numbers 2011 2012 2013 Number of THC Programs 11 22 44 PGY-1 THC Residents 44 154 273 # of residents per year in steady state 132 462 819
  17. 17. Specialty Number of THCs Dental 2 Family Medicine 29 Internal Medicine 5 OB/GYN 2 Pediatrics 3 Psychiatry 3 THC Residency Specialties
  18. 18. THC Accreditation THC Year ACGME AOA ACGME/AOA CODA N/A 2011 5 1 4 1 0 2012 0 9 1 1 0 2013 8 11 2 0 1 Total 13 21 7 2 1
  19. 19. • GW was awarded the Evaluation and Initial Assessment of HRSA Teaching Health Centers contract. • This is a five year contract to better understand this model of community-based residency training, including an examination of the: – costs of training in THCs – contributions to the primary care workforce, particularly in underserved communities. THC Evaluation Project
  20. 20. • THC funding will end in 2015. • THC classes that began in July 2013 do not have funding for the last 9 months of their training. • Future classes will have even less time funded. • THC programs may only be able provide partial training to residents, and are hesitate to recruit or continue to expand their training programs. Challenges for Teaching Health Centers
  21. 21. • On November 23, 2013 Senator Bernie Sanders (I-VT) introduced Senate Bill 1759, Teaching Health Center Reauthorization Act, which provides $800 million in funding to reauthorize the THCGME program for an additional five years. • House staffers are examining a short-term funding patch. This patch will provide approximately $90 million to allow THCs to maintain full funding for all residents in their programs for academic year 2015-2016. Options to Extend Funding for THCs
  22. 22. • The President’s FY 2015 Budget increases funding for primary care residency positions. • THCGME program is not specifically sustained within any new targeted support for GME in the FY 2015 Budget. FY 2015 President’s Budget
  23. 23. THCs are: • Dedicated primary care education centers • De-institutionalized medical training • A means of increasing residency training without “feeding the monster” • Transformative and revolutionary: you pick! Message for the Hill

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