Teaching hospitals train our physician workforce, a role that has taken on increased significance due to an aging population and predictions of a physician shortage. A well-trained physician workforce is essential for providing access to high-quality, high-value health care. The federal government has long recognized its role in supporting the physician workforce across the country and since Medicare’s inception, Medicare graduate medical education (GME) funding has been a significant element in building and maintaining the physician workforce.1 Teaching hospitals drive innovation in health care and provide cutting-edge care to a diverse patient base, including vulnerable populations. Yet GME funding remains threatened.
Teaching hospitals follow a tripartite mission of clinical care, education and research. The three components are tightly interwoven through the organizations and, together, are imbedded into the fabric of teaching hospitals.2 Clinical care is the primary focus of teaching hospitals and is bolstered by education and research.
In 2015, the American Hospital Association (AHA) published a TrendWatch report that provided background on GME and identified several key issues faced by teaching hospitals in training the physician workforce: residency caps that limit funding for training programs; a shortage of residents pursuing primary care specialties; and a growing patient pool due to the newly insured and aging of the population.3 As these issues remain relevant today and new issues have emerged, including new challenges brought on by the COVID-19 pandemic, this paper serves as an update on GME and advances the policy discussion around teaching hospitals.
1. U.S. Government Accountability Office, “HHS Needs Better Information to Comprehensively Evaluate Graduate Medical Education Funding,” GAO-18-240, March 2018.
2. Howard B. Fleishon, “Academic Medical Centers and Community Hospitals Integration: Trends and Strategies.” American College of Radiology 2017;14:45-51.
3. The American Hospital Association (AHA), “Teaching Hospitals: Preparing Tomorrow's Physicians Today, TrendWatch.” June 2015. Available at www.aha. org/guidesreports/2015-06-16-teaching-hospitalspreparing- tomorrows-physicians-today-trendwatchjune.