Every day in the news, you hear about the United States federal budget and the potential political complications if something is done or if nothing is done. And every day in the news you hear about possible cuts in Medicare. What you don't know is that some cuts in Medicare can significantly impact the training of future Family Physicians. What do I mean by this? Well, did you know that residency programs are paid Medicare funds (called Graduate Medical Education funds) going to hospitals? Check out this great article about how residency programs are funded.
So, let's play this out with its potential complications for Family Medicine. If GME funds are cut as they are proposed, then many hospitals with only one residency program (usually a Family Medicine program), may be forced to close the program - thereby decreasing the number of Family Physicians being trained. In those hospitals with multispecialty programs (like large university hospitals), cuts in GME funding would force hospitals to cut their Family Medicine residency slots in favor or more specialty residency slots, which are more lucrative for hospitals. Again, this would decrease the number of Family Physicians being trained.
With GME funding being cut, there are two other disturbing possibilities that may happen. First, residency programs may need to actively seek out financial support from pharma to just keep the program open. Or, some Family Medicine residents may need to pay tuition to complete their training. If not, then those Family Medicine Programs would close as well.
Now, I'm not a part of a residency program. I'm a practicing physician in a community office and a community hospital. How will GME cuts affect me? Well, with less Family Residents being trained, recruiting efforts for our practice just got a lot more difficult - especially since the more veteran physicians will likely retire earlier with the proposed Medicare cuts for physician payment. In addition, with the lack of Family Physician workforce, practices like mine may be forced to look toward midlevel providers to pick up the slack. Now, don't get me wrong, there is nothing wrong with midlevel providers. It's just that it would be nice to be able to choose between a Family Physician and a midlevel provider when the time is right for our practice.
What can be done? Great question. The first step is to educate our Family Physician friends and colleagues of this potential tragic situation. I admit that I didn't know much about this until some good friends alerted me of the situation. The next step is to contact Congress to let your federal legislator know about our concern and our need to #SaveGME. You may have noticed on twitter the hashtag #SaveGME. This is our way to raise awareness about this legislative issue and the future of Family Medicine. I encourage you not only to spread the word, but also to contact Congress via the AAFP Speak Out website. This is the easiest way to locate and to contact your specific legislator. Another way is to use this link for the House and to use this link for the Senate.
Here are the key points that we need to convey to the legislators about #SaveGME:
- There needs to be an "unlinking" of GME funding from hospitals. GME funds need to go to the primary care residency program directly
- GME funding for Family Medicine and other primary care training only
- Do not fund (already profitable) procedural specialty residency programs
Finally, I would like to tip my hat to my Family Physician colleagues who have written blog posts on this issue. Please drop by the blogs below and leave a comment. We're also having our friends on twitter help spread the word about #SaveGME. Feel free to join us with your tweets and retweets. In addition, Dr Pat Jonas will be talking about this issue on his podcast on Tuesday night. And, there may be a twitter chat from #FamMedChat that could be taking place on Thursday night as well. We're trying to spread the word on this issue throughout the social media universe. Please help us do that! The future of Family Medicine could be at stake here. Let Your Voice Be Heard and Make A Difference Today!
Kevin Bernstein from the Future of Family Medicine Blog: GME Funding For Family Medicine Residencies Must Be Preserved Now!
Mark Ryan from the Live In Underserved Medicine Blog: Another Reason To Preserve Medicare Funding: We Need More Doctors
Pat Jonas from the Dr Synonymous Blog: Family Physician Training - Save GME Funding For Primary Care