American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

GME and Workforce

ACS Letter in Response to the House Energy and Commerce Committee's Request for Information on GME Reform

On December 6, 2014 Members of the House Energy and Commerce committee sent out an open letter requesting information on Graduate Medical Education (GME). In response, ACS developed a set of principles on GME reform and used them to formulate a response to the seven questions in the letter. The response was sent to the Committee on January 15, 2015. The ACS Division of Advocacy and Health Policy (DAHP) plans to use the letter and the principles developed in its writing to contribute to ongoing congressional efforts to reform the way that GME is funded and administered.

Updates on Graduate Medical Education and Workforce

The Institutes of Medicine (IOM) report on the financing and governance of the nation’s graduate medical education (GME) system was issued this past summer to little fanfare. It was met with disappointment, and disregard, on Capitol Hill.

There has not been much movement since our last report in the workforce area. The Council on Graduate Medical Education (COGME) released its 21st report, “Improving Value in Graduate Medical Education.” In the report, the COGME recommends an increase in GME funding for high-priority specialties such as general surgery, family medicine, geriatrics, general internal medicine, high-priority pediatric subspecialties, and psychiatry. The COGME acknowledges there are many challenges facing GME such as poor geographic distribution of physicians in relation to population needs and increasing specialization, while primary care remains under-resourced. According to the COGME, part of the reason is that many teaching hospitals have not recognized the need for greater emphasis on primary care training, and curriculum is often inadequate in the areas of population health, care coordination, team-based practice, and other aspects of new systems of care. To address these and other challenges stated in the report, the COGME believes that GME must improve the value the public receives for its investment by increasing partnerships between training programs, teaching hospitals, accreditation organizations, state and federal governments, and other stakeholders to accelerate change. The COGME assumes that greater value in GME means a better targeting of public GME money and more effective training models.

Also in workforce funding, the Patient Protection and Affordable Care Act authorized funding for loan repayments for pediatric subspecialists, including pediatric surgeons, who agree to practice in shortage areas for at least two years. The College sent a letter to appropriators asking that $5 million be included for the program. Unfortunately funding was not included in the omnibus appropriations act that funded the government for the remainder of the fiscal year. We also signed on to a coalition letter to the Office of Management and Budget (OMB) asking the Administration to ask that $5 million in funding be once again included within the Health Resources and Services Administration (HRSA). ACS will continue to push for the funds to be appropriated. The authorization of this program is set to expire after the current fiscal year and Congressman Joe Courtney of Connecticut has recently introduced legislation that would extend this authorization through fiscal year 2018. ACS supports this legislation.

Ensuring an Adequate Surgical Workforce

There is a growing body of evidence pointing to the current and worsening shortage of surgeons available to serve our nation's aging and increasing population. According to the Association of American Medical College's Center for Workforce Studies, there will be a shortage of 46,000 surgeons and medical specialists in the next decade. This is a startling and troubling statistic.

With this looming crisis in the surgical workforce, the American College of Surgeons (ACS) is concerned that focusing efforts only on specialties that fall under the broad rubric of primary care could have severe consequences for surgical patients. We support primary care, and know that it is a needed service for all patients. However, primary care is a service that can be provided by a spectrum of providers. In contrast, surgeons are uniquely qualified to provide necessary and life-saving procedures that no other professional can provide. The needed services of surgeons, which account for an essential part of our health care system, are under great stress because there are more limited numbers of these professionals who are qualified to provide important services to patients.

The ACS Division of Advocacy and Health Policy (DAHP) staff have been fighting to ensure that patients continue to have access to high-quality surgical care by supporting policies and initiatives, such as the ones listed below, that will strengthen the surgical workforce.

Contact: Heather Smith