The Real Value of a Michigan Graduate Medical Education

I often get asked what keeps me up at night. Well, one of the things that I find particularly worrisome these days is the fate of funding for our Medical School’s Graduate Medical Education (GME) programs.

GME includes residency and fellowship training. After medical school, graduates spend three to six years as residents, providing care under the supervision of a licensed physician and honing a specialty. Residency prepares physicians for board certification, which enables them to practice independently. Some physicians go on to complete a second or third residency – fellowships – in complex specialties that require additional training.

Our GME program is the third largest in the U.S. and our residency slots are some of the most competitive in the country. We train new doctors in virtually every medical and surgical specialty, which, in turn, gives Michigan patients access to advanced care.

Unfortunately, federal and state funding for GME has been steadily declining over the last few years. Last year we experienced a 10% cut in Medicaid GME funding from the state, leaving us with state funding that is now lower than it was in 2008. Additionally, we are facing another 10% state cut next year and Congress is debating a 60% reduction in Medicare indirect medical education funding, as originally proposed by the Simpson/Bowles Commission. (Report)

Since there is a cap on the number of residency slots for which we receive funding, the Health System has traditionally funded additional positions as part of our educational and patient care mission. If government support continues to decline, we will be challenged to find ways to make up the difference.

This economic threat to these important medical education programs comes at a time when hospital budgets – including our own – are already strained by years of financial downturn, high rates of uninsurance and underinsurance and the potential implications of health care reform.  Combined, this could compromise the training of physicians at a time when the nation is already concerned about projected physician shortages in the face of a rapidly aging population and the potential addition of millions more Americans to the insurance rolls.

Certainly, these are tough economic times all around.  But, the training and education of the people we will rely on for our health and wellness – one of Governor Snyder’s priorities – shouldn’t be low-hanging fruit for budget cuts, especially in Michigan where health care is a leading employer and a major economic driver.

Clearly, the value and economic impact of GME is undervalued at both the state and federal level.  So, I thought I would use this newsletter to share some numbers that paint a more accurate picture of the true value of a Michigan graduate medical education:

$127.3 million According to a report by Tripp Umbach, that’s the economic impact in 2009 of physicians who completed their residency at U-M and remained in Michigan to set up a practice.

1,122 That’s the number of residents training at UMHS and providing care for patients at UMHHC and at partner facilities like the VA Ann Arbor Health Care System, St. Joseph Mercy Health System, Chelsea Hospital and Hurley Medical Center in Flint.

385 That’s the number of current U-M residents training for careers as primary care physicians, cardiologists, orthopaedic surgeons and general surgeons. A report by the Michigan Center for Health Professions predicted that shortages in the latter three specialties will be the most significant in Michigan by 2020.

94 That’s the number of accredited specialties in which UMHS offers GME training.

60 & 40 Those are the percentages of our incoming class of residents coming from outside Michigan and of U-M residents who stay in Michigan after training, respectively. These are some of the nation’s and the world’s best and brightest – individuals and families who might never consider coming to Michigan if not for our program. (Read From Milan to Marquette to get residents’ perspectives.)

The point is that medical education goes far beyond earning a medical degree, and its value goes far beyond a line or two on a budget proposal.

If we are to successfully help Governor Snyder develop strategies to address anticipated shortages in health care, we need him to support programs that attract and train the physicians that fill those gaps.

If we want the most talented physicians to come to and stay in Michigan to take care of our communities for decades to come, we need Michigan to prioritize investment in the programs that attract and train those physicians.

What do you think? Share your thoughts, comments and perspectives here, on Medicine that Speaks.

10 thoughts on “The Real Value of a Michigan Graduate Medical Education

  1. Melvyn Rubenfire on said:

    Dr. Pescovitz
    Of course our problem is not unique in the US and others are scrambling to find solutions and making program cuts. Assuming there will be no increase in support for GME in the next several years, we’ll clearly have to make very difficult priority decisions.
    Considering how important GME programs are to our patients, quality of care, and the populations we serve, it would seem a major sustaining endowment for GME should be considered. Funding for the endowment could include philanthropy as well as contributions from faculty and hospital revenue.

  2. catherine on said:

    Only 40% of the U M residents stay in Michigan after training. It seems we also need to look at making our Michigan jobs more attractive to these new doctors. The University is investing a great deal of money, time and resources in training residents. Resident (teaching) care may not be as pleasant for patients. It may also be more time consuming for appointments, and lead to smaller patient loads.

    With all the University invests in these residents, we should look at why 60% choose to leave our state, and especially U of M. We lose the benefit of residents skills and a long term career with U of M, when they leave.

    I know at UHS, we are constantly looking for new physicians, and perhaps concentrating on placing these ‘graduates’ within the University would be even more beneficial.

      • Mike Stentz on said:

        While I agree that focusing on retention is always a good idea, it should also be noted that this is not a phenomenon unique to Michigan. The nature of medical training often necessitates moving to a different program at each step of training. If one looks at Massachusetts, which has several of the top residency programs in the country, one also sees a retention rate of 50% following fellowships (, and in fact the national average is about 48% ( The fact that Michigan attracts so many excellent docs in the first place is a real testament to the strength of our training programs.

        I think that the most pressing issue here is that many of the legislators discussing cuts to GME funding don’t realize just how vital that funding is to maintaining our resident work force, which in turn is vital to the functioning of our academic hospital system. We should all talk to our friends, neighbors, and–most importantly–legislators about the need to maintain GME funding at state and national levels.

  3. Hello,
    My name is Moris Laca and I’m a foreign medical graduate and ECFMG certified as well. I’ve been a fully trained general surgeon back in my native country. Actually I hold the position as Clinical Subjects Coordinator here at CTO UMICH.I know that UMICH is restrictive of offering residency position to foreing med.grads but in a given chance I’d officialy pledge and commit myself to exert medicine in MI or wherever the needs are after completing the residency period. I feel that for the future of our national health system and specifically the state of MI it’d be immensely productive and beneficiary to make use of many other foreign med grad’s skills and experience who are looking for a training spot.

    • Ora Pescovitz on said:

      Thank you for your post, Moris. I encourage you to contact the residency director in your area of interest to see what opportunities might exist. You can find this information on the GME web site.

  4. Richman on said:

    In view of today’s financial constraints, I would like to suggest a slight change in GME funding. Why don’t we(the GME programs) accept a yearly fee/tuition from foreign medical graduates to provide them GME training? I know of numerous Foreign medical graduates who are willing to pay to get trained. You have to pay to get any other post graduate education in this country. Then why not GME? Just my 2 cents.

  5. Moris on said:

    Thanks for your very interesting suggestion dear.
    This idea has been in circulation around many medical and faculty centers quite a while ago all around the country. Personally as a Foreign Med.Graduate and ECFMG certified I’d step up and comply with a policy that would make possible my medical training by paying a yearly fee/tuition to the institution who offers this opportunity.Many other fellows in similar situation would do the same thing.I believe that as for the parts involved it would be a “win win” situation.Of course,I don’t think that it would be an easy process to take place but always the rewards and credits usually go to the institutions who embrace the novelties first and we are proud to be one of them.

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