Shifting the Supply of our Health Care Workforce

Recommendations for reform of graduate medical education (GME) subsidies that would ensure the overall support for GME is maintained at its current level but that support should be drawn from a wider pool of resources, including both public and private payers. The reforms should also acknowledge the distinctive and vital role of our academic health centers.

This report recommends the following changes in federal policy to encourage a health system that is responsive to the needs of the market:

• Change the current method of reimbursement for GME under Medicare and Medicaid. Attach the support to the resident as opposed to being part of hospital payments. In effect, allowing the resources to follow the training location.

• Modify the existing formula for calculating reimbursement of GME costs -- "up-weight" primary care residents and "down-weight" non-primary care residents.

• Support primary care residencies at the full payment amount based on the 1995 schedule of reimbursement. Reduction in the overall size of the GME financing pool should come from eliminating specialty residencies.

• By the year 2000, double the numbers of nurse practitioners and nurse midwife training positions from their numbers in 1990.