The American College of Physicians (ACP) and Alliance for Academic Internal Medicine (AAIM) are making efforts to convey a message to the US government authorities on the inefficiency of the funding system allocated for the graduate medical education (GME) in justifying the needs of the workforce in the American hospitals, according to the British Medical Journal (BMJ), May 5th, 2016.

This move made by the medical associations surfaced when Renee Butkus, Director of Health Policy at American College of Physicians, along with her colleagues, wrote in a policy statement published on 3rd May in the ‘Annals of Internal Medicine’ about the GME system stating that it needs to ensure an adequate supply of quality doctors accessible to Americans. It should be noted that the US federal government provides approximately $15 billion annually as ‘GME funding’.

The aim of the respective initiative was to make recommendations and reshape the current funding system and to better align GME with the needs of the nation’s healthcare workforce. The suggestions were regarding the use of GME funds to meet policy goals and to ensure an adequate supply of physicians by providing them the required training facilities and increasing the number of residency positions overall. Another important shortcoming of the current funding procedure was also discussed which abstains the trainees from working outside the premises of the teaching hospitals. The authors of the policy statement urged the government policymakers to allow funding, enabling trainees to gain experience in ‘ambulatory care settings’, which is more relevant to primary care practice.

Moreover, the healthcare professionals suggested that there should be a balance between the specialty mix and the appropriate training sites which requires the uniform distribution of the GME finances across the healthcare system. It was suggested that the true cost of training a resident should be evaluated properly — establishing a ‘single per-resident amount’.

GME is a process which transforms medical students into competent practitioners in their respective field of medicine. There are different programs which fall under the umbrella of GME and are known as residencies and fellowships, allowing trainees to master the art of independent practice. Therefore, GME is of extreme significance in addressing the nation’s workforce needs and is the ultimate determinant of physician output.

According to the BMJ, the estimates indicate a shortage of between 12,500 and 31,100 primary care physicians by 2025 in the US. The current government funded graduate training programs fail to address the needs of the workface and, therefore, hospitals design programs suitable for their staffing needs. The issue was highlighted in the press release by the authors as, “Despite the increasing need for primary care physicians, hospitals have largely favored less costly, higher revenue generating specialty training when adding GME positions.”

Usually the number of workforce in teaching hospitals is determined by the hospitals individually as per their needs, but due to varied reasons the number of the staff has been falling down. The authors highlighted that the funding has remained controversial for a long time.

Primary care, according to the US healthcare system, includes general internal medicine, along with pediatrics and family medicine. An analysis published in BMJ in 2011, focusing on finding out the reasons for the less number of American medical students opting for pursuing ‘primary care’ than two decades ago, suggested the underlying reason to be the shortage of the finances. The findings stated that 86% of medical students who graduated in 2009 were buried under an educational debt of $158,000 (£95 000; €107 000) on average and the overall average debt was found to be $132,000.

Dr Wayne Riley, who is a Medical Director and President at the American College of Physicians, while describing the seriousness of the issue said that the US workforce for the healthcare system is reaching a ‘chock point’. He showed concern on the shortfall of the doctors and blamed the Balanced Budget Act of the 1996 that has ‘capped’ the number of training slots for the practitioners.

AAIM in 2010 and ACP in 2011 individually tried to get the issue into the limelight but now by collaborative efforts they are determined to make a noticeable change which most probably would be by introduction of a new government-authorized policy on the GME budget and workforce issue. The authors in the statement said, “The nation will not be able to expand access, improve outcomes, and decrease expenditures without a national healthcare workforce policy and the appropriate direction of funding to achieve these goals.”

The professionals from the American College of Physicians include internal medicine physicians and subspecialists, while the Alliance for Academic Internal Medicine is an association that represents department chairs, residency and fellowship directors, and other professionals who work in teaching hospitals and medical schools of US and Canada. The two organizations have a collective membership of approximately 152,000 internists, internal medicine subspecialists, medical students, residents, and fellows, according to the BMJ.