Resources for Graduate Medical Education Expansion in California

Mathematica’s Transitional Program Office to accelerate Graduate Medical Education (GME) expansion in California is funded by the California Health Care Foundation and guided by an advisory board of GME experts and leaders.

GME expansion to produce more California physicians, especially in needed specialties and underserved regions of the state, was a top recommendation of the California Future Health Workforce Commission to ensure the future stability and capacity of California’s health care system.  The Transitional Program Office is charged with providing interim leadership and coordinating with existing GME programs, while designing and vetting a permanent statewide GME governance council.

Building on our prior work, this site provides resources to aid health care organizations interested in developing or expanding GME programs as well as policymakers looking to learn more about GME.  Within each topic area we highlight and summarize some key resources.

Topics:

Costs and Benefits of Residency Training

The Cost of Family Medicine Residency Training: Impacts of Federal and State Funding
Source: Family Medicine
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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.

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Reforming the Financing and Governance of GME
Source: New England Journal of Medicine
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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.

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Cost of Incremental Expansion of an Existing Family Medicine Residency Program
Source: Society of Teachers of Family Medicine
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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.

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The Cost of Residency Training in Teaching Health Centers
Source: The New England Journal of Medicine
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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.

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

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Cost Estimates for Training Residents in a Teaching Health Center
Source: Health Resources and Services Administration
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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.

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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
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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.

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Eliminating Residents Increases the Cost of Care
Source: Journal of Graduate Medical Education
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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.

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Costs Associated with Residency Training
Source: Texas Medicine
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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.

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Graduate Medical Education That Meets the Nation's Health Needs
Source: National Academies Press
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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.

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

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Proposed Performance-Based Metrics for the Future Funding of Graduate Medical Education: Starting the Conversation
Source: Academic Medicine
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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.

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

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Expanding GME

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

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

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

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Residency Building and Expansion Toolkit
Source: American Society of Health-System Pharmacists
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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.

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Federal GME Policy

Compendium of Graduate Medical Education Initiatives
Source: American Medical Association
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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
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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.

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Federal Support for Graduate Medical Education: An Overview
Source: Congressional Research Service
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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.

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

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

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GME Metrics/Evaluation

Graduate Medical Education Outcomes and Metrics: Proceedings of a Workshop
Source: National Academies Press
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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.

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Predicting In-State Workforce Retention After Graduate Medical Education Training
Source: Journal of Graduate Medical Education
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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
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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.

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Toward Graduate Medical Education (GME) Accountability: Measuring the Outcomes of GME Institutions
Source: Academic Medicine
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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.

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California GME

Meeting the Demand for Health: Final Report of the California Future Health Workforce Commission
Source: California Future Health Workforce Commission
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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.

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

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Rural GME

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

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Addressing Rural Workforce Shortages and Healthcare Disparities: An Annotated Bibliography
Source: Robert Graham Center
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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.

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Graduate Medical Education Initiatives to Develop the Physician Workforce in Rural Wisconsin
Source: Wisconsin Medical Journal
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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.

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Other State’s GME Expansion Efforts

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

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"The GME Initiative" And GME In States
Source: Annals of Family Medicine
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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.

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GME Expansion in NM: 5-Year Strategic Plan
Source: New Mexico Human Services Department
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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.

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Cost of Incremental Expansion of an Existing Family Medicine Residency Program
Source: Society of Teachers of Family Medicine
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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.

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

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GME IN GEORGIA: Growth, Funding, and Sustainability
Source: Augusta University
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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.

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Medicaid Graduate Medical Education Payments: A 50-State Survey
Source: Association of American Medical Colleges
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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.

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

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Georgia's Innovative Response to GME Expansion
Source: Journal of the Medical Association of Georgia
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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.

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A State-Based Strategy for Expanding Primary Care Residency
Source: Health Affairs Blog
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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.

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GME in the United States: A Review of State Initiatives
Source: Center for Health Services Research
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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.

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New Roles for States In Financing Graduate Medical Education: Minnesota’s Trust Fund
Source: Health Affairs
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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. ­

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Ohio Primary Care Workforce Initiative (OPCWI) User Manual
Source: Ohio Association of Community Health Centers
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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. ­

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Community Health Centers/Teaching Health Centers

The Cost of Residency Training in Teaching Health Centers
Source: The New England Journal of Medicine
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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.

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Cost Estimates for Training Residents in a Teaching Health Center
Source: Health Resources and Services Administration
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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.

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

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

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Mega Teaching Health Centers: A New Model to Power CHCs
Source: Health Affairs Blog
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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. ­

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Teaching Health Centers: A New Paradigm in Graduate Medical Education
Source: Academic Medicine
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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. ­

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