Toward Graduate Medical Education (GME) Accountability: Measuring the Outcomes of GME Institutions

Chen, Candice MD, MPH; Petterson, Stephen PhD; Phillips, Robert L. MD, MSPH; Mullan, Fitzhugh MD; Bazemore, Andrew MD, MPH; O’Donnell, Sarah D. MPH

Academic Medicine:
doi: 10.1097/ACM.0b013e31829a3ce9
Research Reports
Abstract

Purpose: Graduate medical education (GME) plays a key role in the U.S. health care workforce, defining its overall size and specialty distribution and influencing physician practice locations. Medicare provides nearly $10 billion annually to support GME and faces growing policy maker interest in creating accountability measures. The purpose of this study was to develop and test candidate GME outcome measures related to physician workforce.

Method: The authors performed a secondary analysis of data from the American Medical Association Physician Masterfile, National Provider Identifier file, Medicare claims, and National Health Service Corps, measuring the number and percentage of graduates from 2006 to 2008 practicing in high-need specialties and underserved areas aggregated by their U.S. GME program.

Results: Average overall primary care production rate was 25.2% for the study period, although this is an overestimate because hospitalists could not be excluded. Of 759 sponsoring institutions, 158 produced no primary care graduates, and 184 produced more than 80%. An average of 37.9% of internal medicine residents were retained in primary care, including hospitalists. Mean general surgery retention was 38.4%. Overall, 4.8% of graduates practiced in rural areas; 198 institutions produced no rural physicians, and 283 institutions produced no Federally Qualified Health Center or Rural Health Clinic physicians.

Conclusions: GME outcomes are measurable for most institutions and training sites. Specialty and geographic locations vary significantly. These findings can inform educators and policy makers during a period of increased calls to align the GME system with national health needs.

Author Information

Dr. Chen is senior research fellow, National Institute for Minority Health and Health Disparities, and assistant research professor, Department of Health Policy, George Washington University, Washington, D.C.

Dr. Petterson is research director, Robert Graham Center, Washington, D.C.

Dr. Phillips is vice president for research and policy, American Board of Family Medicine, Washington, D.C.

Dr. Mullan is Murdock Head Professor of Medicine and Health Policy, Department of Health Policy, George Washington University, Washington, D.C.

Dr. Bazemore is director, Robert Graham Center, Washington, D.C.

Ms. O’Donnell was research associate, Department of Health Policy, George Washington University, Washington, D.C.

Editor’s Note: Commentaries by R.B. Baron and L.M. Famiglio, M.A. Thompson, and D.F. Kupas appear on pages 1199–1201 and 1202–1205.

Funding/Support: The Josiah Macy Jr. Foundation supported this work. Dr. Chen is supported through a DREAM Award by the National Institute for Minority Health and Health Disparities, National Institutes of Health (NIH).

Other disclosures: None.

Ethical approval: This study was approved by the institutional review boards of George Washington University and the American Academy of Family Physicians.

Disclaimers: The views expressed by Dr. Chen do not represent those of the NIH or the U.S. Department of Health and Human Services. The information and opinions contained in research from the Graham Center do not necessarily reflect the views or policy of the American Academy of Family Physicians.

Previous presentations: Limited findings from this study were presented at the 2012 Association of American Medical Colleges Physician Workforce Research Conference and at the Beyond Flexner Social Mission in Medical Education Conference in May 2012.

Correspondence should be addressed to Dr. Chen, Department of Health Policy, George Washington University, 2121 K St. NW, Washington, DC 20037; telephone: (202) 994-4338; e-mail: cpchen@gwu.edu.

© 2013 by the Association of American Medical Colleges