title: Envisioning a Future Governance and Funding System for Undergraduate and Graduate Medical Education.
abstract: Funding for graduate medical education (GME) and undergraduate medical education (UME) in the United States is being debated and challenged at the national and state levels as policy makers and educators question whether the multibillion dollar investment in medical education is succeeding in meeting the nation's health care needs. To address these concerns, the authors propose a novel all-payer system for GME and UME funding that equitably distributes medical education costs among all stakeholders, including those who benefit most from medical education. Through a "Medical Education Workforce (MEW) trust fund," indirect and direct GME dollars would be replaced with a funds-flow mechanism using fees paid for services by all payers (Medicaid, Medicare, private insurers, others) while providing direct compensation to physicians and institutions that actively engage medical learners in providing clinical care. The accountability of those receiving MEW funds would be improved by linking their funding levels to their ability to meet predetermined institutional, program, faculty, and learner benchmarks. Additionally, the MEW fund would cover learners' UME tuition, potentially eliminating their UME debt, in return for their provision of health care services (after completing GME training) in an underserved area or specialty. This proposed model attempts to increase transparency and enhance accountability in medical education by linking funding to the development of a physician workforce that is able to excel in the evolving health delivery system. Achieving this vision requires physician educators, leaders of academic health centers, policy makers, insurers, and patients to muster the courage to embrace transformational change.
authors.affiliation: J.P. Gold is chancellor, University of Nebraska Medical Center, vice president, University of Nebraska System, and chair, Board of Directors of Nebraska Medicine, Omaha, Nebraska. J.P. Stimpson is associate professor, Department of Health Services Research and Administration, College of Public Health, director, University of Nebraska Medical Center (UNMC) Center for Health Policy, and senior policy analyst, Government Affairs, Office of the Vice-Chancellor for External Affairs, UNMC, Omaha, Nebraska. K.J. Caverzagie is associate professor, Department of Internal Medicine, and associate dean for educational strategy, College of Medicine, University of Nebraska Medical Center, and vice president for education of Nebraska Medicine, Omaha, Nebraska.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Gold
authors.forename: Jim P
authors.initials: JP
authors.lastname: Stimpson
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Caverzagie
mesh_terms: D004503:Education, Medical, Graduate / Q000191:economics*; D004504:Education, Medical, Undergraduate / Q000191:economics*; D005376:Financial Management / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006280:Health Workforce; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008484:Medicaid / Q000191:economics; D008507:Medically Underserved Area; D006278:Medicare / Q000191:economics; D014146:Training Support / Q000458:organization & administration*; D014481:United States