Honoring the Social Contract of Graduate Medical Education Outcomes

Submitted on Fri, 01/21/2022 - 16:42

The graduate medical education (GME) system trains most of the nation’s physicians and receives nearly $19 billion annually to do so. It is heavily subsidized by the public in return for producing physicians that meet society’s needs. However, institutions receiving public funding face potential conflicts of interest, that have prioritized institutional purposes over societal needs. A scholarly perspective article, Measuring Graduate Medical Education Outcomes to Honor the Social Contract, describes a new capacity to assess training outcomes to offer the public and policymakers greater transparency and to improve training. Authors Robert L. Phillips, Brian C. George, Eric S. Holmboe, Andrew W. Bazemore, John M. Westfall, and Asaf Bitton, call systematically assessing GME outcomes to better honor what is now only an implicit social contract.

To create a GME system that better meets the needs of society, there need to be terms of the social contract. Federal funding for GME was added to the Medicare authorizing legislation in 1965. The Medicare funding for GME is allocated primarily to academic teaching hospitals via a complex formula tied to patient care. The authors describe how that same payment process can be linked to workforce data to assess GME outcomes and how it has been demonstrated. Likewise, surgery has used existing data streams to better understand training quality. Feeding outcomes back to programs while publicly reporting them could create good pressures to improve training and its outcomes. To implement GME accountability, authors suggest enabling and directing funders—Medicare, the Veteran’s Health Administration, the Health Resources and Services Administration—to conduct robust assessment, share data across organizations, and invite discussions about better outcomes through public reporting. The authors point to the Children’s GME and Teaching Health Center Programs which already have such requirements. 

Recently, more calls have explicitly emphasized a need for greater accountability for physician workforce outcomes. Authors address the challenges required to track educational outcomes back to the institutions that shape a physician’s education and publicly share data on those outcomes in a transparent manner. But, improving data and methods, and support for research and data development assessments will be more effective and strategic. The authors suggest that future GME oversight should include measurement of the outcomes associated with the systems in which physicians train and practice to enable better accountability, inform future training improvement efforts, and assure the public and funders that GME subsidies are being used in ways that explicitly meet and best honor the implicit social contract.

Read the article here: Measuring Graduate Medical Education Outcomes to Honor the Social Contract

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