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

Caverzagie, Kelly J., MD; Lane, Susan W., MD; Sharma, Niraj, MD, MPH; Donnelly, John, MD; Jaeger, Jeffrey R., MD; Laird-Fick, Heather, MD, MPH; Moriarty, John P., MD; Moyer, Darilyn V., MD; Wallach, Sara L., MD; Wardrop, Richard M. III, MD, PhD; Steinmann, Alwin F., MD

doi: 10.1097/ACM.0000000000002096

Graduate medical education (GME) in the United States is financed by contributions from both federal and state entities that total over $15 billion annually. Within institutions, these funds are distributed with limited transparency to achieve ill-defined outcomes. To address this, the Institute of Medicine convened a committee on the governance and financing of GME to recommend finance reform that would promote a physician training system that meets society’s current and future needs. The resulting report provided several recommendations regarding the oversight and mechanisms of GME funding, including implementation of performance-based GME payments, but did not provide specific details about the content and development of metrics for these payments. To initiate a national conversation about performance-based GME funding, the authors asked: What should GME be held accountable for in exchange for public funding? In answer to this question, the authors propose 17 potential performance-based metrics for GME funding that could inform future funding decisions. Eight of the metrics are described as exemplars to add context and to help readers obtain a deeper understanding of the inherent complexities of performance-based GME funding. The authors also describe considerations and precautions for metric implementation.

K.J. Caverzagie is associate dean for educational strategy, University of Nebraska College of Medicine, and vice president for education, Nebraska Medicine, Omaha, Nebraska.

S.W. Lane is associate professor of medicine, vice chair for education, Department of Medicine, and internal medicine residency program director, Stony Brook Medicine, Stony Brook, New York.

N. Sharma is assistant professor of internal medicine and pediatrics, Harvard Medical School, and program director, Internal Medicine–Pediatrics Residency Program, Brigham and Women’s Hospital and Boston Children’s Hospital, Boston, Massachusetts.

J. Donnelly is program director, Internal Medicine Residency Program, Christiana Care Health System, and clinical associate professor for internal medicine and pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.

J.R. Jaeger is professor of clinical medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

H. Laird-Fick is associate professor of medicine, Michigan State University College of Human Medicine, East Lansing, Michigan.

J.P. Moriarty is associate professor of medicine and program director, Yale Primary Care Residency, Yale University, New Haven, Connecticut.

D.V. Moyer, at the time this article was written, was professor of medicine, Lewis Katz School of Medicine (LKSOM), Temple University, and internal medicine program director, Temple University Hospital, Philadelphia, Pennsylvania. She is now adjunct professor of medicine, LKSOM, Temple University, and executive vice president/chief executive officer, American College of Physicians, Philadelphia, Pennsylvania.

S.L. Wallach is associate professor of medicine, Seton Hall-Hackensack Meridian School of Medicine, and chair and program director of internal medicine, St. Francis Medical Center, Trenton, New Jersey.

R.M. Wardrop III is associate professor of medicine and pediatrics and program director for the combined medicine and pediatrics residency training program, University of North Carolina School of Medicine, Chapel Hill, North Carolina.

A.F. Steinmann is chief of academic medicine, Saint Joseph Hospital, and associate clinical professor of medicine, University of Colorado School of Medicine, Denver, Colorado.

Funding/Support: The AAIM funded the travel expenses for three in-person meetings in Alexandria, Virginia, for all authors. They also dedicated staff time to facilitate activities related to this work. No other funding was provided.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Kelly J. Caverzagie, University of Nebraska College of Medicine, 985524 Nebraska Medical Center, Omaha, NE 68198-5524; telephone: (402) 559-8358; e-mail:; Twitter: @kcaverzagie.

© 2018 by the Association of American Medical Colleges