Today's physician education system produces trained doctors with strong scientific underpinnings in biological and physical sciences as well as supervised practical experience in delivering care. Significant financial public support underlies the graduate-level training of the nation's physicians. Two federal programs--Medicare and Medicaid--distribute billions each year to support teaching hospitals and other training sites that provide graduate medical education.

Graduate Medical Education That Meets the Nation's Health Needs is an independent review of the goals, governance, and financing of the graduate medical education system. This report focuses on the extent to which the current system supports or creates barriers to producing a physician workforce ready to provide high-quality, patient-centered, and affordable health care and identifies opportunities to maximize the leverage of federal funding toward these goals. Graduate Medical Education examines the residency pipeline, geographic distribution of generalist and specialist clinicians, types of training sites, and roles of teaching and academic health centers.

The recommendations of Graduate Medical Education will contribute to the production of a better prepared physician workforce, innovative graduate medical education programs, transparency and accountability in programs, and stronger planning and oversight of the use of public funds to support training. Teaching hospitals, funders, policy makers, institutions, and health care organizations will use this report as a resource to assess and improve the graduate medical education system in the United States.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON THE GOVERNANCE AND FINANCING OF GRADUATE MEDICAL EDUCATION
• Reviewers
• Foreword
• Acknowledgments
• Summary
  • APPROACH TO THE STUDY
  • THE OUTCOMES OF CURRENT GME GOVERNANCE AND FINANCING
  • RECOMMENDATIONS
  • CONCLUSION
• 1. Introduction
  • SCOPE OF THE STUDY
  • BACKGROUND
  • CONTEXT FOR THIS REPORT
  • CONCEPTUAL APPROACH TO THE STUDY
  • GOALS OF THE COMMITTEE
  • METHODS OF THE STUDY
  • ORIENTATION TO THE ORGANIZATION OF THIS REPORT
  • REFERENCES
• 2. Background on the Pipeline to the Physician Workforce
  • PHYSICIAN SUPPLY
  • THE GME PIPELINE—MEDICAL SCHOOL ENROLLMENT
  • GME TRAINING CAPACITY
  • CONCLUSIONS
  • REFERENCES
• 3. GME Financing
  • OVERVIEW OF GME FUNDING
  • MEDICARE
  • MEDICAID
  • HEALTH RESOURCES AND SERVICES ADMINISTRATION
  • VETERANS HEALTH ADMINISTRATION
  • DEPARTMENT OF DEFENSE
  • THE BLACK BOX OF GME COSTS AND BENEFITS
  • CONSEQUENCES AND CONCLUSIONS
  • REFERENCES
• 4. Governance
  • WHAT IS ACCOUNTABILITY
  • GME ACCREDITATION AND CERTIFICATION
  • CONCLUSION
  • REFERENCES
• 5. Recommendations for the Reform of GME Financing and Governance
  • OVERVIEW
  • RECOMMENDATIONS FOR REFORMING GME GOVERNANCE AND FINANCING
  • SUMMARY
  • REFERENCES
• Appendixes
  • Appendix A Abbreviations and Acronyms
  • Appendix B U.S. Senate Letters
  • Appendix C Public Workshop Agendas
  • Appendix D Committee Member Biographies
  • Appendix E Data and Methods to Analyze Medicare GME Payments
  • Appendix F Illustrations of the Phase-In of the Committee's Recommendations

This study was supported by Contract No. 101053-0009 between the National Academy of Sciences and ABIM Foundation; Contract No. 101053-0013 Aetna Foundation; Contract No. 101053-0014 The California Endowment; Contract No. 101053-0002 California HealthCare Foundation; Contract No. 101053-0003 The Commonwealth Fund; Contract No. 101053-0012 East Bay Community Foundation; Contract No. 101053-0010 Health Resources and Services Administration; Contract No. 101053-0006 Jewish Healthcare Foundation; Contract No. 101053-0001 Josiah Macy Jr. Foundation; Contract No. 101053-0007 Kaiser Permanente Institute for Health Policy; Contract No. 101053-0005 The Missouri Foundation for Health; Contract No. 101053-0004 Robert Wood Johnson Foundation; Contract No. 101053-0008 UnitedHealth Group Foundation; and Contract No. 101053-0011 U.S. Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

Suggested citation:

IOM (Institute of Medicine). 2014. Graduate medical education that meets the nation's health needs. Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.