“Its focus is rural primary care. It’s a good first step, but I think we should be looking at community health needs in a balanced approach. Once we have more primary care, what else will we need? Do we need a surgeon in that community a couple days a week? Do we need high risk OB? Do we need cardiologists or not? Psychiatry is another big need in small communities. Should we be growing that as well? So ideally it’s driven by the needs of the community,” said Brunett. “What we’re seeing is a growth in community-based education centers. In the past, it’s always been that one large major academic center, sometimes two, but always a large academic model. That’s where our physicians trained over the years. If that’s the model you’re trained in, you don’t necessarily translate how you learn to practice in a large center to small rural communities,” said Bell. The consortium is beginning to gather information from statewide stakeholders. Based on those conversations, consortium leaders will begin to develop a potential model of support for each community as well as an organizational model for the consortium itself. Ideas range from serving as an advisory group for new programs to managing residency training programs directly. Consortium leaders say the group is likely to facilitate funds and program oversight, given the wide variety of resources needed for any new GME program. “There are communities in the state of Oregon that are poised to start programs, but it’s daunting. The startup costs are tremendously expensive. CMS has a systematic process for reimbursing GME and those funds typically do not flow until a few years after programs are established. There needs to be external funding sources to help communities get off the ground; and together we can pool resources to serve multiple rural areas that single communities can’t do on their own,” said Marcus Alderman, MBA, Director of Operations, Office of Graduate Medical Education, Samaritan Health. A significant investment needed in Oregon Supporters of GME expansion in Oregon say the state will need to make a significant investment in public funding to make it happen. “We’ve had limited assistance and investments primarily oriented towards incentives for physicians to move to underserved areas of the state. Those have been helpful but insufficient to meet our goal of self-sufficiency. In terms of taking a statewide perspective at physician workforce, both a policy agreement and a financial investment will be necessary to meet our goals,” said Moorhead. GME Consortium Steering Committee members have set an aggressive timeline for supporting the development of new GME capacity in the state. “There will be a lot of building that needs to go on, but whether it’s based in the consortium or housed in institutions facilitated by the consortium, from the day you start thinking about starting a residency to the day you matriculate your first trainees is usually about two years,” said Brunett. But for medical students hoping to find a place to train in the future, the clock is ticking. “At this point, I'm not even concerned with the cost of medical school, the low pay of residents, or the high burden of workload at all levels. I just want to make sure that every man and woman that is willing to work hard to serve their community has that opportunity. That is a goal worth fighting for in medical school,” said Latteri. INSTITuTE OF MEDICINE Six Goals for future GMe funding & recommended next Steps1 GOAl #1: Encourage production of a physician workforce better prepared to work in, help lead, and continually improve an evolving health care delivery system that can provide better individual care, better population health, and lower cost. GOAl #2: Encourage innovation in the structures, locations, and designs of GME programs to better achieve Goal #1. GOAl #3: Provide transparency and accountability of GME programs, with respect to the stewardship of public funding and the achievement of GME goals. GOAl #4: Clarify and strengthen public policy planning and oversight of GME with respect to the use of public funds and the achievement of goals for the investment of those funds. GOAl #5: Ensure rational, efficient, and effective use of public funds for GME in order to maximize the value of this public investment. GOAl #6: Mitigate unwanted and unintended negative effects of planned transitions in GME funding methods. 1. Institute of Medicine Graduate Medical Education That Meets the Nation’s Health Needs www.w ww.TheOMA.org Spring 2015 2015 17 17
OMA Spring 2015 Magazine
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