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.