title: Ten-year trends in the financing of family medicine training programs: considerations for planning and policy.
abstract: OBJECTIVE
  The recent Affordable Care Act (ACA) includes physician training provisions to address the US primary care workforce shortage and maldistribution. Policymakers require current graduate medical education (GME) residency finance data to design and implement programs that increase primary care physicians. The University of Washington Family Medicine Network residencies have collaborated for 10 years in collecting and comparing data regarding the revenues and expenses of their training programs. Based on biennial survey results from 2000 to 2010, this study examines changes in the finances of residency training over a decade using a standardized methodology.
  
  
  METHODS
  Data were systematically collected by standardized questionnaire, evaluated for quality and verified, and then analyzed.
  
  
  RESULTS
  The per-resident expense of residency education for these programs increased an average of 63%, and overall residency revenues increased 75%. GME funding per resident increased 47% but decreased as proportionate contribution to overall program revenue.
  
  
  CONCLUSIONS
  The mean cost per resident remained relatively stable over the 10-year period, with a 3.1% overall increase to $27,260 per resident per year. Programs that successfully obtained federally qualified health center (FQHC) status, increased their residency graduate medical education (GME) slots or received other new significant funding, such as state grants, were the most financially stable. Policy solutions would stabilize both federal GME and state Medicaid GME funding and increase reimbursement of primary care practice to maintain the viability of primary care training programs. Conclusions: The mean cost per resident remained relatively stable over the 10-year period, with a 3.1% overall increase to $27,260 per resident per year. Programs that successfully obtained federally qualified health center (FQHC) status, increased their residency graduate medical education (GME) slots or received other new significant funding, such as state grants, were the most financially stable. Policy solutions would stabilize both federal GME and state Medicaid GME funding and increase reimbursement of primary care practice to maintain the viability of primary care training programs.
authors.affiliation: Department of Family Medicine, University of Washington, Mercer Island, WA 98040, USA. drlesko@gmail.com
authors.forename: Sarah
authors.initials: S
authors.lastname: Lesko
authors.forename: Wes
authors.initials: W
authors.lastname: Fitch
authors.forename: Judith
authors.initials: J
authors.lastname: Pauwels
mesh_terms: D003365:Costs and Cost Analysis; D004503:Education, Medical, Graduate / Q000191:economics / Q000639:trends*; D005194:Family Practice / Q000191:economics* / Q000193:education* / Q000639:trends; D005380:Financing, Government; D006801:Humans; D007396:Internship and Residency / Q000191:economics* / Q000639:trends*; D008484:Medicaid / Q000191:economics / Q000639:trends; D011050:Policy Making; D011320:Primary Health Care / Q000191:economics; D011640:Public Policy; D013038:Specialization; D011795:Surveys and Questionnaires; D014146:Training Support / Q000191:economics / Q000639:trends; D014481:United States; D014861:Washington; D000078329:Workforce