The Medical Education Futures Study Blog

Recently I’ve heard arguments suggesting Medicare should increase the number of funded graduate medical education (GME) positions because as U.S. medical schools expand, U.S. medical graduates will no longer get into their chosen residency positions.  This sentiment is often echoed in medical student blogs and chat rooms, with students arguing that there aren’t enough of specific specialty residency positions.

But these arguments beg the question – what demand are we meeting through our federal support of GME?

Supply and demand is a basic tenet of a marketplace economy and it is a concept that Americans generally believe in.  In this situation supply is the number of GME positions, but what demand are we meeting?  Certainly there is a demand generated by medical students for certain kinds of residency positions.  But is Medicare paying hospitals an average of $90k per resident to meet medical student demand for choice residency positions?

Or is demand that of hospitals for cheap labor?  An interesting research study came out this week indicating hospitals are favoring specialty GME positions over primary care positions, with a resultant shift in Medicare funding supporting more specialty training over primary care training.  Hospitals, as a result, are essentially getting a larger workforce for the health care services that are the most highly reimbursed and Medicare is subsidizing the staffing demands of hospitals to increase the provision of costly high intensity, specialty care.

What demand is Medicare meeting through its support of graduate medical education?  I would suggest the demand we should be meeting is that of the nation for the number and kinds of physicians that will produce the most cost-effective, high quality, accessible health care system.