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.

Interesting article on WSJ: The Simple Idea That Is Transforming Health Care

Dear readers,

I thought you might be interested in the Wall Street Journal article below, which mentions the Center for Managing Chronic Disease at the University of Michigan and Dr. Noreen Clark’s Women Breathe Free program. Dr. Clark is a professor of Public Health, Health Behavior and Health Education and of Pediatrics and Communicable Diseases in the Medical School.

The Simple Idea That Is Transforming Health Care:
A focus on quality of life helps medical providers see the big picture—and makes for healthier, happier patients

A Tribute to Michigan by Mitch Albom

I came across this article in the Detroit Free Press and wanted to share it. It is a lovely commentary on the wonders of our state, of Ann Arbor and of the U-M spirit:

Mitch Albom: I’d like to teach the world to … glee

Sometimes, when you live in Michigan, people from out of state ask you, “Why?”

This is a story that answers that question.

I was feeling a little blue this past week. Life’s worries. The usual stuff. I had a family dinner commitment, it was out in Ann Arbor, and though I was tired and didn’t feel like making the trip, the plans already were made.

We met at the Cottage Inn, a large pizza restaurant brimming with college kids. This was in the heart of the University of Michigan, where the semester was heading toward finals. Lots of late evening pepperoni.

We sat at a large table, a bunch of us, the uncles and aunts, nephews, niece, friends, and, near the end of the meal, a white-haired gentleman came over and introduced himself. He said he was the university adviser to the Men’s Glee Club, his name was Carl Smith, and he wanted to know if we had a request.

“A request?”

“Yes. Anything you’d like to hear?”

“You mean a song?”


Now I have been to restaurants where they strum guitars, where they sing opera, where a violinist twirls his bow while couples sip wine.

I have never been to a place that had a glee club.

Surround sound in a pizzeria …

“What are our choices?” I asked.

Carl rattled off a bunch of unfamiliar names, “Varsity,” “Goddess of the Inland Seas.” I shrugged. I am not generally up on glee club repertoire.

“You pick,” I said.

He smiled and said he would. Then he disappeared to the back. We waited around our table, not sure what we had gotten ourselves into.

Suddenly, a small army of young men came walking toward us. They lined the stairs to the second level, they stood along the balcony, they filled the spaces between the tables around us. They were every kind of college male — from the sweat-shirted, unshowered, matted-hair mold to the neatly coiffed, bespectacled version.

In front of them was a gentleman in a gray sport coat, their director, Eugene Rogers. He made a hand motion.

And voices rose.

This is our humble prayer.

Dear Father, bless America,

Oh keep her strong and good.

May her brave songs fly ’round the world

on wings of brotherhood.

The voices were strong, lovely, harmonious, sincere, they filled the restaurant until everyone in the place was listening in stunned silence.

Inspire our songs of loyalty,

And may thy blessing be

On Michigan,

Dear Michigan, our university.

And the night wasn’t over …

When they finished, we rose in applause. The singing kids (I call them kids, they tower over me) were smiling. They hiked their backpacks, readjusted their sweat shirts and scattered.

I later learned this glee club dates to 1859 and is considered one of the best in the country. On Thursday nights it practices, and afterward, it gathers for pizza at the Cottage Inn.

Apparently, the men do a little post-rehearsal singing as well.

We sat in that restaurant feeling uplifted by the impromptu performance. It truly was beautiful singing — and we hadn’t even paid the check yet.

Later, we collected in a dessert place for make-your-own frozen yogurt, and as we sat down, we noticed a group of female college students a few tables over, all wearing the same blue T-shirts.

And suddenly, they broke into a rousing rendition of “Lean On Me,” the Bill Withers classic. They clapped and sang.

Lean on me, when you’re not strong

And I’ll be your friend,

I’ll help you carry on.

When they finished, we applauded again. Either we were incredibly lucky, or someone taped a sign to our backs that read, “Perform for these people!”

But I can’t describe the feeling of hearing youthful singing when you’re down, and how inspiring the sound of young, uninhibited voices can be. They sound like … hope.

And this, out-of-staters, is what can happen when you live in Michigan. Sometimes, when you’re feeling blue, all you need is a little maize.