Panel identifies 21 ways to improve how NY educates its doctors

The Business Review (Albany)

A state panel has identified 21 ways in which New York’s Graduate Medical Education system can be improved.

The New York State Council on Graduate Medical Education (COGME), a group of physicians, medical administrators and other heath care leaders, issued its report to Health Commissioner Dr. Richard Daines on March 25. It makes recommendations concerning quality of care and training; physician supply; cultural competence and diversity; transparency and accountability; and biomedical research.

The group has been working on the report, at Daines’ request, since June 2007. The commissioner wanted to know if the $3.4 billion the state and federal governments were spending to train nearly 16,500 residents in New York each year was yielding the desired results. New York’s GME program is the largest and most expensive in the country, yet there are still shortages of physicians in some parts of the state.

The panel recommended establishing an educational loan repayment program with a service obligation, to encourage new physicians to practice in under-served rural and inner-city communities. It also suggested coupling loan repayment with start-up funding to facilitate the establishment of practices in under-served communities.

Daines also was concerned about whether training was taking place in the right settings. He noted that many of the high-tech services that made the acute care hospitals attractive for specialty education have migrated out of the hospital to ambulatory and free-standing centers. Still, relatively little resident training occurs in ambulatory settings.

“Preparing a properly skilled physician work force for the future requires an appropriate balance of inpatient and ambulatory education experiences,” Daines said in his 2007 remarks to the panel.

COGME, the group of doctors, medical administrators and health care leaders, recommended developing a funding mechanism to support training in ambulatory care sites that deliver “high-quality, comprehensive care that is effective, efficient, safe, timely, patient-centered and equitable.” It also would provide additional funding for primary care training programs.

The panel also was asked to look at whether GME funds had come to be regarded by hospitals as a general revenue stream, rather than as payment for the actual costs of training residents. It recommended that hospitals submit GME budgets to improve transparency and better link funding to training.

Other COGME recommendations include measures to ensure there are no gaps in care when residents are tending to patients; enhanced reimbursement for physicians who commit to providing primary care services for a certain amount of time; investments in the medical education infrastructure and pipeline necessary to support biomedical and clinical research; and medical liability reforms to reduce the high cost of medical malpractice insurance in the state.

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