Resource Center

This report is from the first of two conferences sponsored by the Josia Macy Jr. Foundation focused on ensuring an effective physician workforce for America.  This conference - which took place in October, 2010 in Atlanta, Georgia -  was chaired by Michael M.E. Johns, MD.  This report includes the original papers which were commissioned for the conference:

• Michael Whitcomb wrote a history of GME governance in the United States to provide everyone with a common understanding of how our current system evolved and he highlighted some of the prior calls for reform.
• Clese Erikson and colleagues from the AAMC provided a detailed description and analysis of the numbers of medical residents and residency programs in the United States over the past decade so that we all could understand these trends and analyze their potential impact.
• Norman H. Edelman and Jamie Romeiser outlined the current sources of funds to finance GME in this country, and the AAHC performed a very helpful analysis of the elements of the 2010 Patient Protection and Affordable Care Act that are potentially relevant to the governance and financing of GME.

In addition, the leaders of six organizations that have various roles in governing, financing, or advising the GME system offered their assessments of the current state of the GME system and their thoughts about any future changes. Their presentations are reproduced in this monograph with the highlights of the question and answer sessions that followed each presentation.

The conferees met to discuss the papers, the presentations, and their ideas about reform. The highlights of these rich discussions are captured in this monograph. This process led to a series of consensus conclusions and recommendations that were widely circulated in February 2011 and are reproduced here. As is the case with all Macy conferences and reports, the conferees were participating as individuals and not as representatives of their organizations. Their organizations were not asked to approve or modify the conference conclusions or recommendations.

The guiding principles that the group agreed should drive these recommendations are that GME, as a public good that is largely financed with public dollars, must be accountable to meet the needs of the public. The medical profession and the government, therefore, share the responsibility of assuring that the GME system produces the correct number and mix of physicians with the requisite competencies and skills to meet that public need. The recommendations developed by the group are derived from these principles and are aimed at assuring that we have a more accountable GME system.