Graduate Medical Education That Meets the Nation's Health Needs.

摘要

Since the creation of the Medicare and Medicaid programs in 1965,the public has provided tens of billions of dollars to fund graduate medicaleducation (GME), the period of residency and fellowship that is provided to physicians after they receive an all idiopathic or osteopathic medical degree.2In 2012 alone, public tax dollars contributed more than $15 billion to support residency training, with more than 90 percent coming from the Medicare and Medicaid programs (an estimated $9.7 billion and $3.9 billion, respectively). This funding is essentially guaranteed—regardless of whether the funded programs reflect local, regional, or national health care priorities.The scale of government support for this phase of physician educations unlike that given to any other profession in the nation. The length of postgraduate training for physicians is also unique among the professions: Board certification in a specialty typically requires 3 to 7 years of training,or longer in some sub specialties. The United States has a robust GME system, one emulated by m any other nations, with significant capacity to produce a high-quality physician workforce. Yet, in recent decades, the need for improvements to the System has been highlighted by blue ribbon panels, public- and private sector commissions, provider groups, and Institute of Medicine (OM) committees. Reports from these groups have indicated a range of concerns,including