The 205-page IOM report was written by 21 healthcare policy, hospital system, and physician leaders including former Centers for Medicare & Medicaid Services acting administrator Donald Berwick, MD.
While the IOM report recommends level funding for GME programs from federal sources, it notes that in 1997, Congress capped the number of Medicare-supported physician training slots. Hospitals can add to those, but they just can't get more Medicare funding for those trainees.
The cap is regarded as regionally discriminatory, however, because the level is set to the number of hospital's residents in 1996, "essentially freezing the geographic distribution" of residencies "without regard for future changes in local or regional health workforce priorities, or the geography and demography of the U.S. population.
Committee member David Asprey, Assistant Dean of the Office of Student Affairs at Carver College of Medicine at the University of Iowa, he said, the committee's message is clear that more efficiency is the goal.
"It's more to say that the dollars flow to these entities, who are not necessarily being held accountable for an outcome, such as producing a certain specialty or whatever the case may be," he says. Residency schools "obviously have to remain accredited, but aside from that, there's not a lot of teeth now to affect a desired outcome."
Not all professional organizations were unhappy with the report.