State Health Panel Issues Report on Medical Education Reform

ALBANY, N.Y. (March 25, 2008) – State Health Commissioner Richard F. Daines, M.D., announced today that the new report from the New York State Council on Graduate Medical Education (COGME) identifies 21 recommendations to improve New York's Graduate Medical Education system.

The report, titled Policy Recommendations to the Commissioner of Health, makes recommendations concerning transparency and accountability, quality of care and training, physician supply, cultural competence and diversity, and biomedical research.

In June 2007, the Commissioner turned to COGME for advice regarding the role and financing of GME in New York and addressing particularly the supply, specialization and geographic distribution of the practicing physician workforce; the use of GME funding streams to support hospital costs that have little or no relation to GME; and the relationship between GME and biomedical research.

In response to the Commissioner's request, COGME established five working groups, consulted with a diverse group of health care experts and deliberated as a full Council to develop the following key recommendations:

  • Ambulatory Care. Develop a funding mechanism to support training in ambulatory care sites which deliver high-quality, comprehensive care that is effective, efficient, safe, timely, patient-centered and equitable. Provide additional funding for primary care training programs.
  • Physician Supply. Establish a new educational loan repayment program with a service obligation to encourage new primary care and specialty physicians to practice in underserved rural and inner-city communities. Couple loan repayment with start up funding to facilitate establishment of practices in these communities.
  • Promoting High-Quality Care. "The presence of graduate medical programs should never compromise the delivery of high-quality … care. Because residents may be a 'transitional work force,' it is incumbent on other practitioners… to ensure that gaps in care are closed so that substandard care is not delivered," the Council wrote. The Council recommended that teaching hospitals file an attestation assuring that a single standard of care be provided for all patients regardless of health insurance or other socioeconomic status. This would ensure that GME programs consistently deliver on their well-known capacity to make positive contributions to high standards of care and elimination of health care disparities.
  • Promoting Quality of Training and Patient Care. Improve the practice environment to attract and retain physicians through enhanced reimbursement for physicians based on the time commitment to provide primary care services.
  • Transparency and Accountability in GME Funding. Require the submission of an annual institutional GME budget. Analyze Medicaid payments labeled as GME and redirect funds that are not underwriting GME costs to patient care services in ambulatory and inpatient settings.
  • Research. Invest in the medical education infrastructure and pipeline necessary to support biomedical and clinical research which will attract researchers, research enterprises and biomedical industry and funding to New York.
  • Support medical liability reforms to reduce the high cost of medical malpractice insurance.

State Budget Proposals

These and other COGME recommendations served as the basis for several proposals in the Executive Budget. These include:

  • Doctors Across New York initiative, which provides new physicians with up to $150,000 in medical school loan repayment over a five-year period to practice in medically underserved rural and urban communities. It also provides start-up and recruitment funds of up to $100,000 over two years for new physicians practicing in shortage areas. In addition, funding is proposed for diversity in medicine programs and $5 million to underwrite teaching costs in non-hospital ambulatory care settings.
  • Enhanced Medicaid rates to physicians practicing in underserved communities.
  • Reallocating inpatient dollars to outpatient settings, including hospital clinics, community clinics and physician offices. Enhanced rates for weekend and evening hours and coverage for diabetes and asthma educators.
  • Linking increased outpatient rates for teaching hospitals, starting in 2009, to minimum standards of quality of care and continuity of care in teaching clinics.
  • Redirect GME funds to train physicians in biomedical research and attract nationally prominent faculty to teaching institutions.

Statement from COGME Members

COGME Chairman John Naughton, M.D., Professor and Interim Chairman at the School of Medicine and Biomedical Sciences at the University at Buffalo, said, "The Council members and staff of the state Department of Health responded whole-heartedly and enthusiastically to the Health Commissioner's charge. I fully support this report and what I hope is the beginning of a new era that recognizes the value and responsibilities medical education provides for New York state."

COGME member Herbert Pardes, M.D., President and CEO of New York Presbyterian Hospital, said, "COGME has worked hard to produce recommendations which will sustain and enhance the strength of New York's GME program. New York is a leader in the training and generation of outstanding medical people, and the excellent report generated by COGME should go along way to maintaining that strength and moving forward in a progressive way."

Neil Calman, M.D., President of the Institute for Family Health, said, "This report addresses the critical shortage of primary care physicians and other select specialists in many parts of New York State especially in rural and urban underserved areas. The Council is forging ahead in making bold recommendations to address this problem as well as to improve the quality of graduate medical education, enhance efforts to attract minority residents and faculty and improve the financial viability of practice in New York state to enable us to attract our graduates into practices in underserved areas of the state."

Robert Jacobs, M.D., a respected health care consultant, said, "This report reflects an extraordinary effort by the Council to respond to the many concerns raised by Commissioner Daines. The report also acknowledges the imperative for health care, including all aspects of medical education, to be fiscally responsible. I hope this report will help guide New York state policy, assure that it maintains its leadership position and excellence in GME and provide educational institutions with the insight necessary to adapt to current fiscal realities."

Background

Graduate Medical Education (GME) is the phase of a physician's education referred to as "residency training," and is conducted after completing medical school in teaching hospitals and other clinical settings.

COGME, a diverse body of physicians, medical administrators and health care leaders, provides advice to the Governor and Commissioner of Health on shaping and implementing State policies dealing with GME and the physician workforce. This advisory board was created by Executive Order in 1987 and reauthorized most recently on January 1, 2007.