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DEAN’S MESSAGE
fornia, which is first in population at 39 million, and relative to an adequate number of patients to support the training experiences.
Texas is in worse shape with 26 medical residents/100,000 people. There are also equipment requirements that involve all aspects of
I have included Illinois to round out the top five largest states for the specialty. Then there are staffing requirements, including a Pro-
comparison. gram Director and a Program Coordinator—for each program—as
well as a great number of other professionals to support the residents.
Of course, the geographic distribution or maldistribution is not These include hospital staff, including nursing and administrative
just attributable to the 1996 Balanced Budget Act. States such as positions.
Pennsylvania and New York have a long tradition of academic med-
ical centers that include education as a major mission. Texas, and GME programs incur accreditation and other fees associated with
specifically San Antonio, have large systems that do not consider every residency program—not to mention the salary and benefits
that a priority. Anecdotally, I have heard from members of the com- for the individual residents. One analysis estimated the startup costs
munity that it is more appropriate to train residents in safety net for a single program at $3 million. These costs include adding in-
hospitals. In most northeastern cities, the major systems have abun- frastructure and getting through an initial accreditation process
dant training slots and residents are trained by helping to care for which is no easy task. Even expansion of existing programs can be
insured private patients. costly but is generally less complex due to the existing infrastructure.
Top Five States and Residency Per Capita The article by Drs. Bready and Luber also discusses the return on
the health investment for the community and other factors that are
important to be considered in the funding equa-
tion. GME is a strong investment, and an impor-
tant factor, in the overall healthcare of a
community. The article is an excellent summation
of the work that goes into a residency training pro-
gram and a link to the online version is offered
below. I encourage everyone interested to read it.
Figure 1. Data sources: ACGME Databook2014 -2015 and AAMC National Funding?
Physician Workforce Databook 2015 Efforts to lift the original 1997 cap have been unsuccessful. The
Nevertheless, there is good news in retention of trained physicians. enacted 2014 “Veterans Access, Choice, and Accountability Act”,
Keeping physicians in the state is key to addressing the shortage and instructed the VA to add 1,500 GME residency slots in hospitals
Texas ranks 5th in retention of trained residents, whereas California experiencing shortages. However, VA hospitals depend on affiliate
is 1st, Florida is 4th, New York is 24th and Illinois is 18th. medical school GME programs and without an increase in Medicare
GME support, there may not be enough affiliate residency positions
GME Program Costs to accommodate this VA expansion. For most specialty training pro-
An article, “Costs Associated with Residency Training”, (link grams, the VA patients, though valuable to resident training, do not
represent the full spectrum of conditions/diseases required for com-
below), appeared in the February issue of Texas Medicine. Authored plete training – thus other funded experiences are necessary. A bill
by Lois Bready, MD, our Vice Dean for Graduate Medical Educa- to directly address this by supporting more GME positions at the
tion and Professor and Vice Chair of Anesthesiology, and Phillip Veteran’s Administration (Delivering Opportunities for Care and
Luber, MD, a Professor of Psychiatry and our Associate Dean for Services for Veterans Act; S. 1676) was introduced into the Senate
Graduate Medical Education, it is an important primer in the costs last year, however it has not made any progress.
involved with the complexities and structure of GME programs.
In 2013, a bill was introduced to lift the 1997 cap. It stalled, but
In the article, they discuss how a single position match in March has been recreated in two separate (but nearly identical) bills cur-
is the result of a very complex infrastructure required to support rently before Congress: S.1148 & H.R.2124. In general the two bills
even just one residency program. Residency programs are made up propose:
of professional, technical and other staff, educational endeavors in- • A funding increase in the number of residency slots nationally by
cluding patient care and procedure simulation, as well as ongoing
support and maintenance. Most medical schools have many training 3,000 each year from 2017 to 2021, for a total 15,000 new res-
programs. Besides faculty members, they require a facility that has idency positions
• Setting aside a number of new slots to go to “shortage specialty
Continued on page 38
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