Transitional Program Office to Advance Graduate Medical Education in California

In April 2020, Mathematica established a two-year Transitional GME Program Office to advance GME expansion in California. The Transitional Program Office provides interim leadership related to GME expansion in California; coordinating with GME experts and leaders at the state and national levels and producing resources such as toolkits for health care organizations interested in developing or expanding GME programs.

The Transitional Program Office is guided by an advisory board of GME experts from a variety of training hospitals and Teaching Health Centers representing different California geographic regions, health systems, disciplines, and medical specialties.

Feasibility Grants for GME Naïve Hospitals

Mathematica is working with philanthropic foundations to accelerate GME expansion efforts across California. As part of this work, we oversee a small grant program for non-teaching hospitals interested in exploring the feasibility of starting GME programs. Five grants were awarded in the initial round to hospitals located throughout the state (as shown in the map below). We hope to provide grants to additional hospitals in future rounds.

Map of California showing seven numbered locations

Funded Proposals

  1. Adventist Health Saint Helena (St. Helena, CA)
  2. Chinese Hospital (San Francisco, CA)
  3. Good Samaritan Hospital (Oildale, CA)
  4. St. Francis Medical Center (Lynwood, CA)
  5. Mountains Community Hospital (Lake Arrowhead, CA)

Additional Approved Proposals

  1. Aurora Charter Oak Hospital (Covina, CA)
  2. Stanford Health Care – ValleyCare (Pleasanton, CA)
 

Toolkit Resources

Our team developed a toolkit of resources for GME expansion in California.

  Download presentation

  Download fact sheet

Published Literature on GME Expansion

 
 

Costs and Benefits of Residency Training

The Cost of Family Medicine Residency Training: Impacts of Federal and State Funding
Source: Family Medicine
Go to resource

This study examined family medicine residencies to determine the costs and revenue per resident during the study period. The study found that overall expenses increased more than 70 percent from 2002 to 2014, and the median cost per resident increased 93.7 percent to $179,353. The study also found that total revenue per resident increased by only 44.5 percent from 2006 to 2016. The analysis showed that by 2016, there was a $47,164 difference between the median cost to train a resident and the revenue they brought to the institution. The researchers concluded that the excess expenses must be made up by other funding sources to ensure the viability of these family medicine residency programs.

Pauwels, J., and A. Weidner. “The Cost of Family Medicine Residency Training: Impacts of Federal and State Funding.” Family Medicine, vol. 50, no. 2, 2018, pp. 123–127. Available at https://www.ncbi.nlm.nih.gov/pubmed/29432627. Accessed May 27, 2020.

Citation
 
Reforming the Financing and Governance of GME
Source: New England Journal of Medicine
Go to resource

Because of the discrepancy between the geographic distribution of GME training programs and the needs of the U.S. population, along with other limitations of GME training programs, the Institute of Medicine convened a Committee on the Governance and Financing of GME in 2014. This article describes the purpose of the committee, the committee’s overarching goals for the future configuration of GME financing and governance, and the committee’s recommendation for distribution of GME funding.

Wilensky, G.R., and D.M. Berwick. “Reforming the Financing and Governance of GME,” New England Journal of Medicine, vol. 371, no. 9, August 18, 2014, pp. 792–793. Available at https://www.nejm.org/doi/full/10.1056/NEJMp1406174. Accessed May 27, 2020.

Citation
 
The Direct, Indirect, and Intangible Benefits of Graduate Medical Education Programs to their Sponsoring Institutions and Communities
Source: Journal of Graduate Medical Education
Go to resource

This article examines the benefits of residency programs in five areas: residents/fellows, institutions, local communities, university sponsors and affiliates, and the greater community/nation. The study found that the benefits of a residency program extend far beyond the training location and that the review of a residency program based solely on direct profits and losses might be insufficient. The authors argue that it is best to take into account direct and indirect revenue and expenses—with care given to examine the value of care given to poor and vulnerable populations—of the residency program as well as the intangible benefits of having a residency program (compared with the intangible benefits of other hospital-sponsored programs) when determining the financial sustainability of a residency program.

Pugno, P., W.R. Gillanders, and S.M. Kozakowski. “The Direct, Indirect, and Intangible Benefits of Graduate Medical Education Programs to their Sponsoring Institutions and Communities.” Journal of Graduate Medical Education, vol. 2, no. 2, June 2010, pp. 154–159. Available at https://www.jgme.org/doi/full/10.4300/JGME-D-09-00008.1. Accessed May 27, 2020.

Citation
 
Moving the Financing of Graduate Medical Education Into the 21st Century
Source: Journal of the American Medical Association
Go to resource

Grischkan, J.A., A.B. Friedman, and A. Chandra. “Moving the Financing of Graduate Medical Education Into the 21st Century.” Journal of the American Medical Association, vol. 324, no. 11 2020, pp. 1035–1036. Available at https://jamanetwork.com/journals/jama/fullarticle/2770076.

Citation
 
Sponsoring Institution Interests, Not National Plans, Shape Physician Workforce in the United States
Source: Family Medicine
Go to resource

Rittenhouse, D.R., A.S. Ament, and K. Grumbach. “Sponsoring Institution Interests, Not National Plans, Shape Physician Workforce in the United States.” Family Medicine, vol. 52, no. 8, 2020, pp. 551–556. Available at https://journals.stfm.org/familymedicine/2020/september/rittenhouse-2020-0088/.

Citation
 
The Graduate Medical Education (GME) Gold Rush: GME Slots and Funding as a Financial Asset
Source: Academic Medicine
Go to resource

Aizenberg, D.J., and L.S. Logio. “The Graduate Medical Education (GME) Gold Rush: GME Slots and Funding as a Financial Asset.” Academic Medicine, vol. 95, no. 4, April 2020, pp. 503–505. Available at https://journals.lww.com/academicmedicine/Fulltext/2020/04000/The_Graduate_Medical_Education__GME__Gold_Rush_.13.aspx?context=FeaturedArticles&collectionId=8.

Citation
 
Cost of Incremental Expansion of an Existing Family Medicine Residency Program
Source: Society of Teachers of Family Medicine
Go to resource

Ashkin, E., W. Newton, B. Toomey, R. Lingley, and C. Page. “Cost of Incremental Expansion of an Existing Family Medicine Residency Program.” Society of Teachers of Family Medicine, vol. 49, no. 7, 2017, pp. 544–547. Available at https://www.stfm.org/FamilyMedicine/Vol49Issue7/Ashkin544. Accessed May 27, 2020.

Citation
 
The Cost of Residency Training in Teaching Health Centers
Source: The New England Journal of Medicine
Go to resource

Regenstein, M., K. Nocella, M.M. Jewers, and F. Mullan. “The Cost of Residency Training in Teaching Health Centers.” The New England Journal of Medicine, vol. 375, no. 7, August 18, 2016, pp. 612–614. Available at https://www.nejm.org/doi/10.1056/NEJMp1607866. Accessed May 27, 2020.

Citation
 
Cost Estimates for Training Residents in a Teaching Health Center
Source: Health Resources and Services Administration
Go to resource

Health Resources and Services Administration. “Cost Estimates for Training Residents in a Teaching Health Center.” Rockville, MD: Health Resources and Services Administration, n.d. Available at https://bhw.hrsa.gov/sites/default/files/bhw/grants/thc-costing-fact-sheet.pdf. Accessed May 27, 2020.

Citation
 
New Internal Medicine Residency Program at a Community Hospital Improves Mortality Without Increasing the Cost or Length of Stay: A Two-Year Follow Up
Source: Hospital Medicine Annual Conference, 2019
Go to resource

Savoj, J., C. Mikhail, R. Gulati, N. Ayutyanont, and A. Popa. “New Internal Medicine Residency Program at a Community Hospital Improves Mortality Without Increasing the Cost or Length of Stay: A Two-Year Follow Up.” Hospital Medicine Annual Conference, 2019. Available at  https://scholarlycommons.hcahealthcare.com/teaching-learning/1/. Accessed June 2, 2020.

Citation
 
Eliminating Residents Increases the Cost of Care
Source: Journal of Graduate Medical Education
Go to resource

DeMarco, D.M., R. Forster, T. Gakis, and R.W. Finberg. “Eliminating Residents Increases the Cost of Care.” Journal of Graduate Medical Education, vol. 9, no. 4, 2017, pp. 514–517. Available at  https://www.jgme.org/doi/full/10.4300/JGME-D-16-00671.1. Accessed Jun 2, 2020.

Citation
 
Costs Associated with Residency Training
Source: Texas Medicine
Go to resource

Bready, L., and M.P. Luber. “Costs Associated with Residency Training.” Texas Medicine, vol. 112, no. 2, 2016, pp. 44–49. Available at https://www.texmed.org/template.aspx?id=35119. Accessed June 2, 2020.

Citation
 
Graduate Medical Education That Meets the Nation's Health Needs
Source: National Academies Press
Go to resource

Eden, J., D. Berwick, and G. Wilensky. Graduate Medical Education That Meets the Nation's Health Needs. Chicago, IL: National Academies Press, 2014: https://www.ncbi.nlm.nih.gov/books/NBK248027/. Accessed June 2, 2020.

Citation
 
Opening the ‘Black Box’ of GME Costs and Benefits: A Conceptual Model and a Call for Systematic Studies
Source: Journal of Graduate Medical Education
Go to resource

Wynn, B. “Opening the ‘Black Box’ of GME Costs and Benefits: A Conceptual Model and a Call for Systematic Studies.” Journal of Graduate Medical Education, vol. 7, no. 1, March 2015, pp. 125–127. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4507905/pdf/i1949-8357-7-1-125.pdf. Accessed June 2, 2020.

Citation
 
Proposed Performance-Based Metrics for the Future Funding of Graduate Medical Education: Starting the Conversation
Source: Academic Medicine
Go to resource

Caverzagie, K.J., S.W. Lane, N. Sharma, J. Donnelly, J.R. Jaeger, H. Laird-Fick, J.P. Moriarty, et al. “Proposed Performance-Based Metrics for the Future Funding of Graduate Medical Education: Starting the Conversation.” Academic Medicine, vol. 93, no. 7, July 2018, pp. 1002–1013. Available at https://journals.lww.com/academicmedicine/Fulltext/2018/07000/Proposed_Performance_Based_Metrics_for_the_Future.20.aspx. Accessed June 2, 2020.

Citation
 
Teaching Hospitals and FQHCs Can Partner to Alleviate Community Healthcare Provider Shortages and Reduce Training Costs
Source: FQHC.org Blog
Go to resource

Garces de Marcilla, J., K. Abreu, L. Peterson, and S. Weinman. “Teaching Hospitals and FQHCs Can Partner to Alleviate Community Healthcare Provider Shortages and Reduce Training Costs.” FQHC.org Blog, 2017. Available at https://www.fqhc.org/blog/2017/4/27/unusual-hospital-fqhc-partnerships-address-payment-and-access-issues. Accessed June 2, 2020. ­

Citation
 
 
 
 

Expanding GME

Establishing the First Residency Program in a New Sponsoring Institution: Addressing Regional Physician Workforce Needs
Source: Journal of Graduate Medical Education
Go to resource

In this article, directors of a new internal medicine residency program describe and reflect on their experience developing the program. The article includes the timeline and the key steps they followed to develop the program. The authors also discuss lessons learned, including that new residency programs can offer opportunities for innovation and that organizational culture, which is complex, will affect implementation of a program.

Bush, R.W., R.F. LeBlond, and R.D. Ficalora. “Establishing the First Residency Program in a New Sponsoring Institution: Addressing Regional Physician Workforce Needs.” Journal of Graduate Medical Education, vol. 8, no. 5, December 2016, pp. 655–661. Available at https://www.jgme.org/doi/full/10.4300/JGME-D-15-00749.1. Accessed May 27, 2020.

Citation
 
Starting a New Residency Program: A Step-by-Step Guide for Institutions, Hospitals, and Program Directors
Source: Medical Education Online
Go to resource

This article outlines the steps taken by Baylor College of Medicine and The Children’s Hospital of San Antonio to set up a new pediatric residency program in 2014 and can serve as a guide for future programs. The article includes information about infrastructure-building, curriculum development, accreditation, marketing, and recruitment for a new program. The article provides practical, “nuts and bolts” advice for those interested in creating a new residency.

Barajaz M., and T. Turner. “Starting a New Residency Program: A Step-by-Step Guide for Institutions, Hospitals, and Program Directors.” Medical Education Online, vol. 21, no. 1, 2016. Available at 10.3402/meo.v21.32271. Accessed June 2, 2020.

Citation
 
The VA MISSION Act of 2018: A Potential Game Changer for Rural GME Expansion and Veteran Health Care
Source: Journal of Rural Health
Go to resource

Albanese, A.P., E.T. Bope, K.M. Sanders, and M. Bowman. “The VA MISSION Act of 2018: A Potential Game Changer for Rural GME Expansion and Veteran Health Care.” Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association, vol. 36, no. 1, 2020, pp. 133–136. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973037/.

Citation
 
Logistics of Establishing a New Internal Medicine-Primary Care Program
Source: Alliance for Academic Internal Medicine
Go to resource

Shalaby, M., S.M. Higgins, J. Ojeda, and P. O’Rourke. “Logistics of Establishing a New Internal Medicine-Primary Care Program.” In Primary Care Track Toolkit, Second Edition. Alexandria, VA: Alliance for Academic Internal Medicine, 2020. Available at http://higherlogicdownload.s3.amazonaws.com/IM/fecab58a-0e31-416b-8e56-46fc9eda5c37/UploadedImages/Documents/resources/Primary_Care_Toolkit_Second_Edition.pdf#page=10.

Citation
 
For-Profit Systems Embrace Graduate Medical Education to Meet Demand for Primary Care Physicians
Source: Becker’s Hospital Review
Go to resource

Brown, J., M. Hendricks, and D. David. “For-Profit Systems Embrace Graduate Medical Education to Meet Demand for Primary Care Physicians.” Becker’s Hospital Review, 2019. Available at https://www.beckershospitalreview.com/hospital-physician-relationships/for-profit-systems-embrace-graduate-medical-education-to-meet-demand-for-primary-care-physicians.html. Accessed June 2, 2020.

Citation
 
Cost of Incremental Expansion of an Existing Family Medicine Residency Program
Source: Society of Teachers of Family Medicine
Go to resource

Ashkin, E., W. Newton, B. Toomey, R. Lingley, and C. Page. “Cost of Incremental Expansion of an Existing Family Medicine Residency Program.” Society of Teachers of Family Medicine, vol. 49, no. 7, 2017, pp. 544–547. Available at https://www.stfm.org/FamilyMedicine/Vol49Issue7/Ashkin544. Accessed May 27, 2020.

Citation
 
Mega Teaching Health Centers: A New Model to Power CHCs
Source: Health Affairs Blog
Go to resource

Rieselbach, R., P. Shin, G. Nycz, K. Pereira, N. Short, E. McConnell, and K. Schmader. “Mega Teaching Health Centers: A New Model to Power CHCs.” Health Affairs Blog, 2016. Available at https://www.healthaffairs.org/do/10.1377/hblog20161013.057067/full/. Accessed June 2, 2020. ­

Citation
 
Residency Building and Expansion Toolkit
Source: American Society of Health-System Pharmacists
Go to resource

American Society of Health-System Pharmacists. “Residency Building and Expansion Toolkit.” n.d. Available at https://www.nmhanet.org/files/PharmacistResidencyToolkit.pdf. Accessed June 2, 2020.

Citation
 
 
 
 

Federal GME Policy

Compendium of Graduate Medical Education Initiatives
Source: American Medical Association
Go to resource

This compendium, compiled by the American Medical Association, outlines current and prospective proposals for changing the way graduate medical education (GME) is funded in the United States. The first section, Current GME Initiatives, outlines positions on GME reform put forward by prominent medical and educational associations, including the Institute of Medicine, the American Medical Association, the Association of American Medical Colleges, and the American Academy of Family Physicians. The second section, Proposals for GME Reform, outlines potential opportunities, challenges, and questions associated with different approaches to GME reform, including an all-payer model, the grow-your-own approach, and Teaching Health Center and Primary Care Residency Expansion grants.

American Medical Association. “Compendium of Graduate Medical Education Initiatives.” Chicago, IL: American Medical Association, 2016. Available at https://www.ama-assn.org/system/files/2019-02/gme-compendium.pdf. Accessed May 27, 2020.

Citation
 
Reforming the Financing and Governance of GME
Source: New England Journal of Medicine
Go to resource

Because of the discrepancy between the geographic distribution of GME training programs and the needs of the U.S. population, along with other limitations of GME training programs, the Institute of Medicine convened a Committee on the Governance and Financing of GME in 2014. This article describes the purpose of the committee, the committee’s overarching goals for the future configuration of GME financing and governance, and the committee’s recommendation for distribution of GME funding.

Wilensky, G.R., and D.M. Berwick. “Reforming the Financing and Governance of GME,” New England Journal of Medicine, vol. 371, no. 9, August 18, 2014, pp. 792–793. Available at https://www.nejm.org/doi/full/10.1056/NEJMp1406174. Accessed May 27, 2020.

Citation
 
The Graduate Medical Education (GME)Gold Rush: GME Slots and Funding as a Financial Asset
Source: Academic Medicine
Go to resource

Aizenberg, D.J., and L.S. Logio. “The Graduate Medical Education (GME) Gold Rush: GME Slots and Funding as a Financial Asset.” Academic Medicine, vol. 95, no. 4, April 2020, pp. 503–505. Available at https://journals.lww.com/academicmedicine/Fulltext/2020/04000/The_Graduate_Medical_Education__GME__Gold_Rush_.13.aspx?context=FeaturedArticles&collectionId=8.

Citation
 
Moving the Financing of Graduate Medical Education Into the 21st Century
Source: Journal of the American Medical Association
Go to resource

Grischkan, J.A., A.B. Friedman, and A. Chandra. “Moving the Financing of Graduate Medical Education Into the 21st Century.” Journal of the American Medical Association, vol. 324, no. 11 2020, pp. 1035–1036. Available at https://jamanetwork.com/journals/jama/fullarticle/2770076.

Citation
 
Sponsoring Institution Interests, Not National Plans, Shape Physician Workforce in the United States
Source: Family Medicine
Go to resource

Rittenhouse, D.R., A.S. Ament, and K. Grumbach. “Sponsoring Institution Interests, Not National Plans, Shape Physician Workforce in the United States.” Family Medicine, vol. 52, no. 8, 2020, pp. 551–556. Available at https://journals.stfm.org/familymedicine/2020/september/rittenhouse-2020-0088/.

Citation
 
On the Looming Physician Shortage and Strategic Expansion of Graduate Medical Education
Source: Cureus
Go to resource

Ahmed, H., and J B. Carmody. “On the Looming Physician Shortage and Strategic Expansion of Graduate Medical Education.” Cureus, vol. 12, no. 7, 2020, pp. e9216. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430533/.

Citation
 
The VA MISSION Act of 2018: A Potential Game Changer for Rural GME Expansion and Veteran Health Care
Source: Journal of Rural Health
Go to resource

Albanese, A.P., E.T. Bope, K.M. Sanders, and M. Bowman. “The VA MISSION Act of 2018: A Potential Game Changer for Rural GME Expansion and Veteran Health Care.” Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association, vol. 36, no. 1, 2020, pp. 133–136. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973037/.

Citation
 
Federal Support for Graduate Medical Education: An Overview
Source: Congressional Research Service
Go to resource

Heisler, Elayne J., Sidath Viranga Panangala, Bryce H.P. Mendez, Marco A. Villagrana, and Alison Mitchell. “Federal Support for Graduate Medical Education: An Overview.” Washington, DC: Congressional Research Service, 2018. Available at https://fas.org/sgp/crs/misc/R44376.pdf. Accessed June 2, 2020.

Citation
 
HHS Needs Better Information to Comprehensively Evaluate Graduate Medical Education Funding
Source: Government Accountability Office
Go to resource

Government Accountability Office. “HHS Needs Better Information to Comprehensively Evaluate Graduate Medical Education Funding.” Washington, DC: Government Accountability Office, 2018. Available at https://www.gao.gov/products/GAO-18-240. Accessed June 2, 2020.

Citation
 
Opening the ‘Black Box’ of GME Costs and Benefits: A Conceptual Model and a Call for Systematic Studies
Source: Journal of Graduate Medical Education
Go to resource

Wynn, B. “Opening the ‘Black Box’ of GME Costs and Benefits: A Conceptual Model and a Call for Systematic Studies.” Journal of Graduate Medical Education, vol. 7, no. 1, March 2015, pp. 125–127. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4507905/pdf/i1949-8357-7-1-125.pdf. Accessed June 2, 2020.

Citation
 
Graduate Medical Education That Meets the Nation's Health Needs
Source: National Academies Press
Go to resource

Eden, J., D. Berwick, and G. Wilensky. Graduate Medical Education That Meets the Nation's Health Needs. Chicago, IL: National Academies Press, 2014: https://www.ncbi.nlm.nih.gov/books/NBK248027/. Accessed June 2, 2020.

Citation
 
The Veterans Access, Choice, and Accountability Act of 2014: Examining Graduate Medical Education Enhancement in the Department of Veterans Affairs
Source: Academic Medicine
Go to resource

Chang, B.K., and J.L. Brannen. “The Veterans Access, Choice, and Accountability Act of 2014: Examining Graduate Medical Education Enhancement in the Department of Veterans Affairs.” Academic Medicine, vol. 90, no. 9, 2015, pp. 1196–1198. Available at https://journals.lww.com/academicmedicine/fulltext/2015/09000/The_Veterans_Access,_Choice,_and_Accountability.13.aspx. Accessed June 2, 2020.

Citation
 
 
 
 

GME Metrics/Evaluation

Graduate Medical Education Outcomes and Metrics: Proceedings of a Workshop
Source: National Academies Press
Go to resource

The National Academies of Sciences hosted a workshop in 2017 on the need to measure, track, and report GME outcomes. One of the findings of the workshop was that GME programs in their current form lack a shared understanding of what they should accomplish and operate independently of one another. Currently, no national mechanism exists for comprehensive assessments of whether GME programs accomplish their goals. Workshop participants discussed the value of measuring GME based on patient outcomes and community outcomes as well as how previous attempts to measure GME outcomes focused on metrics that were measurable but not important. Ultimately, the participants came up with seven key themes that had emerged during the workshop discussions, including the idea that measuring and reporting GME outcomes is important to justify public (Medicaid) funding.

Martin, P., M. Zindel, and S. Nass. “Graduate Medical Education Outcomes and Metrics: Proceedings of a Workshop.” Chicago, IL: National Academies Press, 2018. Available at https://www.nap.edu/download/25003#. Accessed May 27, 2020.

Citation
 
Predicting In-State Workforce Retention After Graduate Medical Education Training
Source: Journal of Graduate Medical Education
Go to resource

In this study, researchers produced a scoring tool that helped to predict whether physicians who completed their graduate medical education in an institution in Michigan would remain in Michigan after completing their training. Additional predictive variables in the study included being born in Michigan, competing medical school or obtaining a bachelor’s degree in Michigan, and completing a primary care residency. Their analysis showed that completing graduate medical education in Michigan was predictive of remaining in Michigan to practice medicine. The findings of this study support the theory that having ties to a state could influence a physician’s decision to remain and practice medicine after completing their training.

Koehler, T., J. Goodfellow, A. Davis, J. Spybrook, and J. van Schagen. “Predicting In-State Workforce Retention After Graduate Medical Education Training.” Journal of Graduate Medical Education, vol. 9, no. 1, February 2017, pp. 73–78. Available at https://www.jgme.org/doi/pdf/10.4300/JGME-D-16-00278.1. Accessed May 27, 2020.

Citation
 
Proposed Performance-Based Metrics for the Future Funding of Graduate Medical Education: Starting the Conversation
Source: Academic Medicine
Go to resource

Caverzagie, K.J., S.W. Lane, N. Sharma, J. Donnelly, J.R. Jaeger, H. Laird-Fick, J.P. Moriarty, et al. “Proposed Performance-Based Metrics for the Future Funding of Graduate Medical Education: Starting the Conversation.” Academic Medicine, vol. 93, no. 7, July 2018, pp. 1002–1013. Available at https://journals.lww.com/academicmedicine/Fulltext/2018/07000/Proposed_Performance_Based_Metrics_for_the_Future.20.aspx. Accessed June 2, 2020.

Citation
 
Toward Graduate Medical Education (GME) Accountability: Measuring the Outcomes of GME Institutions
Source: Academic Medicine
Go to resource

Chen, C., S. Petterson, R. Phillips, F. Mullan, A. Bazemore, and S. O’Donnell. “Toward Graduate Medical Education (GME) Accountability: Measuring the Outcomes of GME Institutions.” Academic Medicine, vol. 88, no. 9, September 2013, pp. 1267–1280. Available at https://journals.lww.com/academicmedicine/fulltext/2013/09000/Toward_Graduate_Medical_Education__GME_.31.aspx. Accessed June 2, 2020.

Citation
 
 
 
 

California GME

Meeting the Demand for Health: Final Report of the California Future Health Workforce Commission
Source: California Future Health Workforce Commission
Go to resource

The California Future Health Workforce Commission compiled a final report as the culmination of two years of research into the future of the California health workforce. Its report examined the key issues facing California: that seven million Californians currently live in Health Professional Shortage Areas and that an upcoming wave of physician retirements is likely to exacerbate this crisis. The commission’s report included 27 recommendations, with 10 priority recommendations, for increasing opportunities for Californians in the health professions, expanding training and education in California, and increasing the capacity and retention of health care workers. One of the priority recommendations was to expand the number of primary care physician and psychiatry residency positions in California, with a goal of training an additional 1,872 primary care physicians and 2,202 psychiatrists by 2030.

California Future Health Workforce Commission. “Meeting the Demand for Health: Final Report of the California Future Health Workforce Commission.” February 2019. Available at https://futurehealthworkforce.org/wp-content/uploads/2019/03/MeetingDemandForHealthFinalReportCFHWC.pdf. Accessed May 27, 2020.

Citation
 
Preparing Physicians to Care for Underserved Patients: A Look at California's Teaching Health Centers
Source: California Health Care Foundation
Go to resource

This article discusses the six teaching health centers in California, and their efforts to increase the number of primary care physicians in the state, especially in underserved areas. These teaching health centers are funded by grants from the Health Resources and Services Administration, but the future of this funding is uncertain. This analysis found that teaching health centers in California attract more applicants than they can admit, pointing to a need for increased training capacity. The analysis also found that most graduates of these programs continue to practice in underserved areas but may relocate to different geographic areas upon completion of their training.

Coffman, J., M. Fix, and K. Himmerick. “Preparing Physicians to Care for Underserved Patients: A Look at California's Teaching Health Centers.” Oakland, CA: California Health Care Foundation, 2016. Available at https://www.chcf.org/publication/preparing-physicians-to-care-for-underserved-patients-a-look-at-californias-teaching-health-centers/. Accessed June 2, 2020. ­

Citation
 
Primary Care Access in California and Disparities Across Major Cities
Source: Primary Care Development Corporation
Go to resource

Weisbeck, K., A. Allard, K. Manko, M.M. Ford, and L. Cohen. “Primary Care Access in California and Disparities Across Major Cities.” New York, NY: Primary Care Development Corporation, 2020. Available at https://www.pcdc.org/wp-content/uploads/Points-on-Care-_-Issue-4-_-CA.pdf.

Citation
 
 
 
 

Rural GME

Graduate Medical Education Financing: Sustaining Medical Education in Rural Places
Source: WWAMI Rural Health Research Center, University of Washington
Go to resource

This policy brief looks at funding issues surrounding Rural Training Track (RTT) GME programs. A survey of RTT program directors and administrations found that RTT programs are often more responsible for program budget deficits than urban programs. The survey also found that these programs rely heavily on program administrators who donate their time to the program without compensation and on program directors who receive little compensation for the time they spend doing administrative work. The long-term viability of these RTT programs may be impacted by unstable funding arrangements.

Patterson D.G., D. Schmitz, R. Longenecker, D. Squire, and S.M. Skillman. “Graduate Medical Education Financing: Sustaining Medical Education in Rural Places.” Seattle, WA: WWAMI Rural Health Research Center, University of Washington, May 2015. Available at http://depts.washington.edu/uwrhrc/uploads/RTT_Finances_PB.pdf. Accessed June 2, 2020. 

Citation
 
Addressing Rural Workforce Shortages and Healthcare Disparities: An Annotated Bibliography
Source: Robert Graham Center
Go to resource

This annotated bibliography from the Robert Graham Center is split into two sections. The first reviews the current state of rural health care and the second reviews graduate medical education (GME) financing. Section one includes rural health needs, the mortality gap between urban and rural settings, and factors that contribute to this divergence. Section two includes an overview of the current GME financing structure, its impact on training, specific training programs financing, financing of safety net health care systems, and loan repayment programs. New policies regarding the structure of financing and physician workforce (rural and urban) are reviewed as possible solutions to financing complications. The analysis presented demonstrates a critical need for a national strategy that addresses rural workforce shortages and innovative financing of rural health care systems that will improve the quality and value of the American health care system.

Khatib, D., A. Huffstetler, and A. Bazemore. “Addressing Rural Workforce Shortages and Healthcare Disparities: An Annotated Bibliography.” Washington, DC: Robert Graham Center, n.d. Available at  https://www.graham-center.org/content/dam/rgc/documents/publications-reports/reports/RuralHealth-AnnotatedBibliography-COGME.pdf. Accessed May 27, 2020.

Citation
 
The VA MISSION Act of 2018: A Potential Game Changer for Rural GME Expansion and Veteran Health Care
Source: Journal of Rural Health
Go to resource

Albanese, A.P., E.T. Bope, K.M. Sanders, and M. Bowman. “The VA MISSION Act of 2018: A Potential Game Changer for Rural GME Expansion and Veteran Health Care.” Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association, vol. 36, no. 1, 2020, pp. 133–136. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973037/.

Citation
 
Graduate Medical Education Initiatives to Develop the Physician Workforce in Rural Wisconsin
Source: Wisconsin Medical Journal
Go to resource

Bruksch-Meck, K., B. Crouse, G. Quinn, L. McCart, and K. Traxler. “Graduate Medical Education Initiatives to Develop the Physician Workforce in Rural Wisconsin.” Wisconsin Medical Journal, vol. 117, no. 5, 2018, pp. 201–207. Available at https://wmjonline.org/wp-content/uploads/2018/117/5/201.pdf. Accessed June 2, 2020.

Citation
 
 
 
 

Other State’s GME Expansion Efforts

Starting New Accreditation Council for Graduate Medical Education (ACGME) Residency Programs in a Teaching Hospital
Source: Contemporary Topics in Graduate Medical Education [Working Title]
Go to resource

Starting a new ACGME approved residency program can positively impact patient care, medical education, hospital operations, and the community as whole. This requires a significant amount of commitment, time, and preparation. The initial application and accreditation process should start early and requires a thorough understanding on the ACGME requirements. Building a new residency program involves collaboration among various stakeholders, starting with the teaching hospital, ACGME, and the Center of Medicare and Medicaid services (CMS). It is prudent to also consider the operational and logistical issues such as budget, faculty and administrative staff hire, faculty time for administrative duties, and educational space for faculty and residents. It is vital to recognize how the institution’s strengths and weaknesses match up to these requirements. A robust educational and clinical curriculum in line with ACGME’s core competencies and useful educational collaboration among various programs is critical for effective program. Recruiting and developing the appropriate faculty members is another important aspect for a successful program. The final challenge is recruiting residents that will fit well into the new residency program. Lastly, we discuss the challenges and tips to mitigate the risks of disappointment in the process of starting and creating a flagship residency program.

Goodbred, A., R. Snyder, J. Sweeny, C. Marchionni, B. Bhatt, G. Domer, A. Davis, S. Yaich, J. Orlando, J. Dalkiewicz, M. Geary, V. Yellapu and P. Kaur. “Starting New Accreditation Council for Graduate Medical Education (ACGME) Residency Programs in a Teaching Hospital.” Contemporary Topics in Graduate Medical Education [Working Title], vol. 2, 2020, doi:10.5772/intechopen.73480. Available at https://www.intechopen.com/online-first/starting-new-accreditation-council-for-graduate-medical-education-acgme-residency-programs-in-a-teac. Accessed February 15, 2021.  

Citation
 
A Statewide Strategy for Expanding Graduate Medical Education by Establishing New Teaching Hospitals and Residency Programs
Source: Academic Medicine
Go to resource

This article begins with a discussion of the current state of graduate medical education (GME) funding in the United States as well as the medical education system in Georgia. The authors then describe the steps that Georgia took to expand GME, including establishing new residency programs in the state, noting that residents who train in Georgia are more likely to remain in the state throughout their careers. The article outlined the costs and infrastructure needs associated with transitioning from a community hospital to a teaching hospital and how funding from the state of Georgia was dispersed to create about 400 new residency positions beginning in 2013. The article concludes with a discussion of the lessons learned and challenges faced by the new GME programs.

Nuss, M., B. Robinson, and P. Buckley. “A Statewide Strategy for Expanding Graduate Medical Education by Establishing New Teaching Hospitals and Residency Programs.” Academic Medicine, vol. 90, no. 9, September 2015, pp. 1264–1268. Available at https://journals.lww.com/academicmedicine/fulltext/2015/09000/A_Statewide_Strategy_for_Expanding_Graduate.27.aspx. Accessed May 27, 2020.

Citation
 
"The GME Initiative" And GME In States
Source: Annals of Family Medicine
Go to resource

This article was about the GME Initiative- a grassroots group made up of medical educators, advocates, and leaders - and their work to reform graduate medical education. The GME Initiative workgroup strives to “connect the dots” between the intent of GME reform strategies and the actual results. The GME Initiative hosted its first summit focused on states in 2017, and representatives from 33 states attended. Interested parties can contact the GME Initiative leaders for more information about how to get involved.

Davis A., and M. Singh. “The GME Initiative” And GME In States.” Annals of Family Medicine, vol. 16, no. 5, September 2018, pp. 468-469. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6130997/. Accessed June 5, 2020.

Citation
 
Improving the Return on Investment of Graduate Medical Education in North Carolina
Source: North Carolina Medical Journal
Go to resource

Newton, W., N. Wouk, and J. Spero. “Improving the Return on Investment of Graduate Medical Education in North Carolina.” North Carolina Medical Journal, vol. 77, no. 2, March 2016, pp. 121–127. Available at https://www.ncmedicaljournal.com/content/77/2/121.long. Accessed November 4, 2020.

Citation
 
GME Expansion in NM: 5-Year Strategic Plan
Source: New Mexico Human Services Department
Go to resource

New Mexico Human Services Department. “GME Expansion in NM: 5-Year Strategic Plan.” Santa Fe, NM: New Mexico Human Services Department, 2019. Available at https://www.hsd.state.nm.us/uploads/files/GME%20Expansion/GMEStrategicPlanRFA2019_11_29_ACS%20(002).pdf. Accessed June 2, 2020.

Citation
 
Cost of Incremental Expansion of an Existing Family Medicine Residency Program
Source: Society of Teachers of Family Medicine
Go to resource

Ashkin, E., W. Newton, B. Toomey, R. Lingley, and C. Page. “Cost of Incremental Expansion of an Existing Family Medicine Residency Program.” Society of Teachers of Family Medicine, vol. 49, no. 7, 2017, pp. 544–547. Available at https://www.stfm.org/FamilyMedicine/Vol49Issue7/Ashkin544. Accessed May 27, 2020.

Citation
 
State-Based Approaches to Reforming Medicaid-Funded Graduate Medical Education
Source: Carolina Health Workforce Research Center
Go to resource

Fraher, E., and J. Spero. “State-Based Approaches to Reforming Medicaid-Funded Graduate Medical Education.” Chapel Hill, NC: Carolina Health Workforce Research Center, 2017. Available at https://www.shepscenter.unc.edu/wp-content/uploads/2017/01/GMEI-States-Initiatives-Summit-1_25_17FINAL.pdf. Accessed June 2, 2020.

Citation
 
GME IN GEORGIA: Growth, Funding, and Sustainability
Source: Augusta University
Go to resource

Kornegay, D. “GME IN GEORGIA: Growth, Funding, and Sustainability.” Augusta, GA: Augusta University, 2016. Available at https://www.augusta.edu/ahec/documents/gme_white_paper.pdf. Accessed June 2, 2020.

Citation
 
Medicaid Graduate Medical Education Payments: A 50-State Survey
Source: Association of American Medical Colleges
Go to resource

Henderson, T. “Medicaid Graduate Medical Education Payments: A 50-State Survey.” Washington, DC: Association of American Medical Colleges, 2016. Available at https://store.aamc.org/downloadable/download/sample/sample_id/246/. Accessed June 2, 2020.

Citation
 
An Assessment of Opportunities for Graduates of Texas Medical Schools to Enter Graduate Medical Education in Texas
Source: Texas Higher Education Coordinating Board
Go to resource

Texas Higher Education Coordinating Board. “An Assessment of Opportunities for Graduates of Texas Medical Schools to Enter Graduate Medical Education in Texas.” Austin, TX: Texas Higher Education Coordinating Board, 2016. Available at http://www.thecb.state.tx.us/DocID/PDF/8649.PDF. Accessed June 2, 2020.

Citation
 
Georgia's Innovative Response to GME Expansion
Source: Journal of the Medical Association of Georgia
Go to resource

Nuss, M., and P. Buckley. “Georgia's Innovative Response to GME Expansion.” Journal of the Medical Association of Georgia, vol. 104, 2015, pp. 10–11. Available at https://www.ncbi.nlm.nih.gov/pubmed/26492741. Accessed June 2, 2020.

Citation
 
A State-Based Strategy for Expanding Primary Care Residency
Source: Health Affairs Blog
Go to resource

Kaufman, A., and C. Alfero. “A State-Based Strategy for Expanding Primary Care Residency.” Health Affairs Blog, 2015. Available at https://www.healthaffairs.org/do/10.1377/hblog20150731.049707/full/. Accessed June 2, 2020.

Citation
 
GME in the United States: A Review of State Initiatives
Source: Center for Health Services Research
Go to resource

Spero, J.C., E.P. Fraher, T.C. Ricketts, and P.H. Rockey. “GME in the United States: A Review of State Initiatives.” Chapel Hill, NC: Center for Health Services Research, 2013. Available at  https://www.shepscenter.unc.edu/wp-content/uploads/2013/09/GMEstateReview_Sept2013.pdf. Accessed June 2, 2020.

Citation
 
New Roles for States In Financing Graduate Medical Education: Minnesota’s Trust Fund
Source: Health Affairs
Go to resource

Blewett, L.A., and V. Weslowski. “New Roles for States In Financing Graduate Medical Education: Minnesota’s Trust Fund.” Health Affairs, vol. 19, no. 1, 2000. Available at https://www.healthaffairs.org/doi/full/10.1377/hlthaff.19.1.248. Accessed June 2, 2020. ­

Citation
 
Ohio Primary Care Workforce Initiative (OPCWI) User Manual
Source: Ohio Association of Community Health Centers
Go to resource

Ohio Association of Community Health Centers. “Ohio Primary Care Workforce Initiative (OPCWI) User Manual.” Columbus, OH: Ohio Association of Community Health Centers, n.d. Available at https://cdn.ymaws.com/www.ohiochc.org/resource/resmgr/opcwi/OPCWI_User_Manual_Webpage.pdf. Accessed June 2, 2020. ­

Citation
 
 
 
 

Community Health Centers/Teaching Health Centers

The Cost of Residency Training in Teaching Health Centers
Source: The New England Journal of Medicine
Go to resource

In this article, the authors discuss the impetus for Congress’s authorization of the Teaching Health Center GME program as part of the Affordable Care Act and assess the cost for a Teaching Health Center to provide GME residency training. The Teaching Health Center GME program was designed to increase the number of primary care physicians and dentists trained in community-based settings with the goal of bolstering long-term clinical capacity in those settings. It provides a set amount per resident per year to the Teaching Health Centers that participate, dependent on Congressional appropriations. The initial amount appropriated was $150,000 per resident. The authors analyzed to determine whether this amount reflects the costs incurred by a Teaching Health Center and found it to be reasonably reflective of the actual cost.

Regenstein, M., K. Nocella, M.M. Jewers, and F. Mullan. “The Cost of Residency Training in Teaching Health Centers.” The New England Journal of Medicine, vol. 375, no. 7, August 18, 2016, pp. 612–614. Available at https://www.nejm.org/doi/10.1056/NEJMp1607866. Accessed May 27, 2020.

Citation
 
Cost Estimates for Training Residents in a Teaching Health Center
Source: Health Resources and Services Administration
Go to resource

The Health Resources and Services Administration contracted with George Washington University to collect and analyze information from Teaching Health Centers on their costs and income associated with training residents. The analysis found that Teaching Health Centers serve low-income communities and provide significant amounts of uncompensated care. The analysis also showed that there were variations in the training costs of different Teaching Health Centers; small, new, and rural programs had higher per-resident costs. Overall, the median cost of training a resident in a Teaching Health Centers in 2017 was estimated to be $157,602.

Health Resources and Services Administration. “Cost Estimates for Training Residents in a Teaching Health Center.” Rockville, MD: Health Resources and Services Administration, n.d. Available at https://bhw.hrsa.gov/sites/default/files/bhw/grants/thc-costing-fact-sheet.pdf. Accessed May 27, 2020.

Citation
 
Teaching Hospitals and FQHCs Can Partner to Alleviate Community Healthcare Provider Shortages and Reduce Training Costs
Source: FQHC.org Blog
Go to resource

Garces de Marcilla, J., K. Abreu, L. Peterson, and S. Weinman. “Teaching Hospitals and FQHCs Can Partner to Alleviate Community Healthcare Provider Shortages and Reduce Training Costs.” FQHC.org Blog, 2017. Available at https://www.fqhc.org/blog/2017/4/27/unusual-hospital-fqhc-partnerships-address-payment-and-access-issues. Accessed June 2, 2020. ­

Citation
 
Preparing Physicians to Care for Underserved Patients: A Look at California's Teaching Health Centers
Source: California Health Care Foundation
Go to resource

Coffman, J., M. Fix, and K. Himmerick. “Preparing Physicians to Care for Underserved Patients: A Look at California's Teaching Health Centers.” Oakland, CA: California Health Care Foundation, 2016. Available at https://www.chcf.org/publication/preparing-physicians-to-care-for-underserved-patients-a-look-at-californias-teaching-health-centers/. Accessed June 2, 2020. ­

Citation
 
Mega Teaching Health Centers: A New Model to Power CHCs
Source: Health Affairs Blog
Go to resource

Rieselbach, R., P. Shin, G. Nycz, K. Pereira, N. Short, E. McConnell, and K. Schmader. “Mega Teaching Health Centers: A New Model to Power CHCs.” Health Affairs Blog, 2016. Available at https://www.healthaffairs.org/do/10.1377/hblog20161013.057067/full/. Accessed June 2, 2020. ­

Citation
 
Teaching Health Centers: A New Paradigm in Graduate Medical Education
Source: Academic Medicine
Go to resource

Chen C., F. Chen, and F. Mullan. “Teaching Health Centers: A New Paradigm in Graduate Medical Education.” Academic Medicine, vol. 87, no. 12, 2012, pp. 1752–1756. Available at https://pubmed.ncbi.nlm.nih.gov/23095929/. Accessed June 2, 2020. ­

Citation
 
 

Advisory Board

  • Anthony Albanese, MD, FACP, DFASAM Director, MISSION Act, RIFDI & GME Expansion
    VA Office of Academic Affiliations (OAA)
  • Lupe Alonzo-Diaz, MA
    President/CEO
    Physicians for a Healthy California
  • Theresa Azevedo, MPA
    Associate Institutional Director and DIO
    Kaiser Permanente Northern California
  • Peter Broderick, MD, MEd
    Director of Undergraduate Medical Education, Valley Region
    Sutter Health
  • Janet Coffman
    Professor of Health Policy and Family and Community Medicine
    University of California, San Francisco
  • J. Craig Collins, MD, MBA
    DIO
    Kaiser Permanente Southern California
  • David Connett, DO
    Vice Dean
    Western University of Health Sciences – College of Osteopathic Medicine
  • James Cruz, MD
    Senior Medical Director
    Blue Shield of CA Promise Health Plan
  • Jeremy Fish, MD
    Program Director, Family Medicine Residency
    John Muir Health
  • Hector Flores, MD
    Co-Director, Family Medicine Residency Program
    White Memorial Medical Center
  • C. Freeman, MD, MBA
    Adult and Geriatric Psychiatrist
    Los Angeles, CA
  • Dean Germano, MHSC
    CEO
    Shasta Community Health Center
  • Daniel Giang, MD
    Associate Dean, GME
    Loma Linda University School of Medicine
  • Kevin Grumbach, MD
    Chair, Family and Community Medicine
    University of California, San Francisco
  • Caryn Rizell
    Acting Deputy Director
    Office of Statewide Health Planning and Development
  • William Henning, DO
    Member
    California Healthcare Workforce Policy Commission
  • Robert McCarron, DO
    Vice Chair of Education and Integrated Care, Department of Psychiatry and Human Behavior
    University of California, Irvine
  • Cathryn Nation, MD
    Vice President – Health Services
    University of California Office of the President
  • Kiki Nocella, MHA, PhD
    Director
    WIPFLi
  • Michelle Nuss, MD
    Campus Associate Dean for GME
    Augusta University/University of Georgia Medical Partnership
  • Richard Riemer, DO
    Senior Associate Dean
    Touro University California
  • Mark Servis, MD
    Vice Dean for Medical Education
    University of California, Davis
  • Stacey Silverman, PhD
    Deputy Assistant Commissioner, Academic Quality
    Texas Higher Education Coordinating Board
  • Mannat Singh, MPA
    Director
    The GME Initiative
  • Efrain Talamantes, MD, MBA
    Medical Director
    AltaMed Institute for Health Equity
  • Lori Weichenthal, MD, FACEP
    Assistant Dean of GME and DIO
    UCSF Fresno
  • Lori Winston, MD
    DIO
    Kaweah Delta Health Care District

Key Staff

Diane Rittenhouse

Diane Rittenhouse

Senior Fellow

View Bio Page
Amanda Lechner

Amanda Lechner

Researcher

View Bio Page
Amanda Ament

Alexandra Ament

Independent Contractor