texas gme salsberg 4 8 08v4
DESCRIPTION
From TMA GME Stakeholder ForumTRANSCRIPT
![Page 1: Texas Gme Salsberg 4 8 08v4](https://reader036.vdocument.in/reader036/viewer/2022062702/554b8b2ab4c9056d5f8b54ad/html5/thumbnails/1.jpg)
The Role of GME in Meeting Physician Workforce Needspresentation to:
The Texas Health Care Policy Council and The Texas Medical Association 2008 Stakeholder Forum
Edward SalsbergSenior Associate Vice PresidentDirector, Center for Workforce Studies
April 8, 2008
![Page 2: Texas Gme Salsberg 4 8 08v4](https://reader036.vdocument.in/reader036/viewer/2022062702/554b8b2ab4c9056d5f8b54ad/html5/thumbnails/2.jpg)
Aligning GME Policies with Physician Workforce Needs: Overview
1. Identifying, measuring and monitoring workforce needs
• Needs are multi-faceted and no agreement on how to measure
2. Aligning GME policies
• No easy levers
3. Establishing a process and assigning responsibility
![Page 3: Texas Gme Salsberg 4 8 08v4](https://reader036.vdocument.in/reader036/viewer/2022062702/554b8b2ab4c9056d5f8b54ad/html5/thumbnails/3.jpg)
Defining Physician Workforce Needs
• Overall supply/numbers
• Geographic distribution
• Specialty distribution
• Competencies
• Diversity
![Page 4: Texas Gme Salsberg 4 8 08v4](https://reader036.vdocument.in/reader036/viewer/2022062702/554b8b2ab4c9056d5f8b54ad/html5/thumbnails/4.jpg)
Some possible goals
Increasing the total number of GME positionsTraining in community based settingsTraining in shortage specialtiesInterdisciplinary – team training and careImproved training methods and competenciesEducational innovationsTraining in underserved regionsInfluencing post training practice setting
![Page 5: Texas Gme Salsberg 4 8 08v4](https://reader036.vdocument.in/reader036/viewer/2022062702/554b8b2ab4c9056d5f8b54ad/html5/thumbnails/5.jpg)
How to Measure and Project Physician Needs in a State• No single correct number; needs vary based on wide range of
factors such as demographics and disease patterns of population, and extent of poverty
• Can compare to benchmarks such as national average or similar states but very indirect measure of need
• Importance of considering current system and needs and desired system
• For assessing today’s needs can consider from perspective of: providers (hospitals, clinics, health plans: i.e. recruitment
difficulties) practitioners (i.e. waiting times, not taking new patients,
assessment of shortages) patients (i.e. access problems and waiting time)
• For forecasting, critical to assess projected population demographics, utilization patterns and health system
• Recommend a systematic review in the short run and a comprehensive study of needs in the state in the longer run
![Page 6: Texas Gme Salsberg 4 8 08v4](https://reader036.vdocument.in/reader036/viewer/2022062702/554b8b2ab4c9056d5f8b54ad/html5/thumbnails/6.jpg)
Decision Makers and Leverage Points
Medical students and residents Medical schools Residency programs Teaching hospitals RRCs Health care delivery system
![Page 7: Texas Gme Salsberg 4 8 08v4](https://reader036.vdocument.in/reader036/viewer/2022062702/554b8b2ab4c9056d5f8b54ad/html5/thumbnails/7.jpg)
Methods of Distributing Funds
• As part of reimbursement system or from a central fund
• Standard amount per resident or variable amount based on some criteria
• Grants in response to RFP
• Distribute to teaching hospitals, medical schools, consortia or other organizations
• Limit eligibility, such as to specific areas or specialties
![Page 8: Texas Gme Salsberg 4 8 08v4](https://reader036.vdocument.in/reader036/viewer/2022062702/554b8b2ab4c9056d5f8b54ad/html5/thumbnails/8.jpg)
The VA Model for GME Expansion
The Critical Needs/Emerging Specialties RFP
New Affiliations and New Sites of Care RFP
Benefits
• Identify priorities
• Targeting to high need areas and specialties
• Encourage innovation
• Rational process
![Page 9: Texas Gme Salsberg 4 8 08v4](https://reader036.vdocument.in/reader036/viewer/2022062702/554b8b2ab4c9056d5f8b54ad/html5/thumbnails/9.jpg)
What about encouraging primary care?
• Needs in both primary care and non-primary care specialties such as those serving the elderly
• Need to improve reimbursement and delivery system
• Currently more primary care GME positions than applicants Need to encourage more applicants Reimbursement policies Loan repayment Supportive grants to assist rural sites
• Education and training with teams of PAs, NPs and others
![Page 10: Texas Gme Salsberg 4 8 08v4](https://reader036.vdocument.in/reader036/viewer/2022062702/554b8b2ab4c9056d5f8b54ad/html5/thumbnails/10.jpg)
Closing Thoughts
• Establish a systematic process to identify physician needs on an on-going basis
• Encourage flexibility to support training in the most appropriate setting
• Support for federal legislation to lift or modify the cap on Medicare GME
• Set aside some GME funds to be distributed via RFP to encourage new initiatives: Interdisciplinary teamsEstablishment of programs in specialties with
shortages in regions of the stateInnovations in education
![Page 11: Texas Gme Salsberg 4 8 08v4](https://reader036.vdocument.in/reader036/viewer/2022062702/554b8b2ab4c9056d5f8b54ad/html5/thumbnails/11.jpg)