Evolution of the GME Initiative: 2010-2019
GME reform and the creation of the GME Initiative

Starting in 2010, the Colorado Commission on Family Medicine (COFM) has been committed to reforming the Graduate Medical Education (GME) payment system to increase the primary care physician workforce. Several years ago, the COFM board brought these concerns to Senator Mark Udall who recommended the baord develop a consortium of family medicine leaders in more GME-disadvantaged states who have relationships with their state senators. In July 2011, COFM organized the GME Initiative in Denver. Representatives from ten Western and Midwestern states gathered to evaluate the Medicare GME payment structure. As a result of looking at GME payment structures, an article was published in March 2013 issue of Family Medicine (Voorhees, et al. "A Proposal for Reform of the Structure and Financing of Primary Care Graduate Medical Education." Family Medicine 2013; 45(3): 164-170).

Growing the GME Initiative

In 2014 the GME Initiative coordinated another event aimed at reforming the Medicare GME payment system. The GME Summit, held in Washington D.C. June 19th-20th 2014, was timed to coincide with the release of the IOM Report on GME reform. The two day event was designed to educate policy makers by explaining why the GME payment system is not increasing the primary care workforce. The goal was to increase the likelihood that the IOM report would mobilize legislative action. On the first day, two teams conducted 22 individual meetings with legislative health aides. On day two, a panel of eight speakers delivered the message to an audience of over 120 legislative health aides in the Capitol Visitor's Center. 

The message to policy makers included three essential changes to GME in order to increase the primary care physician workforce:

  1. Set a goal: to improve health care outcomes and reduce costs, the primary care workforce should be increased to at least 40% of physicians.

    • Effective healthcare sytesms have a physician workforce comprised of 40-50% primary care​

    • The current US physician workforce is  33% primary care

    • The US GME system currently produces primary care physicians at a rate of less than 25% of the total physician workforce

    • The nation needs an unequivocal policy statement to correct this imbalance                             

  2. Measure primary care accurately: the number of physicians in primary care should be counted five years after graduating from medical school, not at the time of entering residency.

    • The ​resulting data will accurately reflect whether residencies are truly producing primary care physicians, as opposed  to starting in an internal medicine or pediatrics residency and then going on to sub-specialize in an area such as cardiology or pulmonology                 

  3. Change the routing of GME payments: payment should be made directly to programs and sponsoring organizations where primary care training occurs.

    • Examples include direct funding of Teaching Health Centers, educational consortia, and/or residency programs rather than teaching hospitals​

    • Uncouple GME payments from Medicare hospital payments

    • Payment to a hospital based on its percentage of Medicare patients does not correlate with the cost of running a residency

Where we are now

Following the GME Summit West in 2015, three workgroups formed to begin work on speciic issues: legislation, forming strategic partnerships, and state GME initiatives

All participants, members, and partners of the GME Initiative also participate in larger monthly conference calls. The calls are designed to increase collaboration among family medicine leaders, and to share ideas and plan action around GME Reform. 

Since then we have hosted a summit in Albuquerque in 2017, focused on States Initiatives, and another in Atlanta in 2018 where a working group of GME Initiative partners and participants tackled comprehensive reform. In March of 2019 we headed to Washington DC for an Advocacy Summit, and in 2020 we're back in Denver, Colorado

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