The physician shortage has prompted renewed scrutiny of how the U.S. trains physicians, and whether graduate medical education programs are structured to meet the country’s workforce needs.
Some leaders say the biggest opportunities lie in expanding community-based training models and reducing administrative pressures that discourage physicians from primary care.
Justin Frederick, MD, chief medical officer of graduate medical education at Renton, Wash.-based Providence, joined Becker’s to discuss ways to address training gaps and how reducing administrative burden for physicians will be essential to making primary care careers more sustainable and attractive for the next generation.
Editor’s note: This interview was edited lightly for clarity and length.
Question: If you could change one or two structural elements of GME to better address the physician shortage, what would they be?
Dr. Justin Frederick: First, permanent funding for the Teaching Health Center model, with an increased per-resident amount to reflect rising costs. That would be impactful at both the federal and state levels. Increasing funded cap positions beyond the 1,200 recently added would also be significant.
The reason I think this model is so effective is that it sets a per-resident amount that isn’t dependent on [diagnosis-related groups] or inpatient-to-resident ratios, and the funding doesn’t flow through acute care facilities. It also allows us to embed residents directly in the communities they serve. We have family medicine, internal medicine and psychiatry residents truly embedded in these communities.That has done an incredible job of giving them opportunities to serve vulnerable populations, build relationships and address the maldistribution of specialties in rural and underserved areas.
Second, reducing administrative burden for primary care physicians. We need to allow them to focus on patient care. That includes inbox management and other administrative pressures. Many of these structural changes can happen at the local level.
Q: Looking five to 10 years ahead, what are your biggest concerns about the physician workforce, and where do you see optimism?
JF: I’m optimistic about this generation’s commitment to health equity and meaningful work. They’re energetic and enthusiastic, even amid funding gaps. They also see the importance of preventive healthcare. I hope over the next decade we move upstream and become more proactive rather than reactive.
My concerns center on GME funding mechanisms and political division, which can impede meaningful reform.
Q: Is there anything you’d like to see change in GME to push more toward proactive care?
JF: Some of that is embedded in education — increasing emphasis on prevention, lifestyle medicine and upstream interventions. There’s growing interest in those areas.
I’ll share an example. In 1965, when President Lyndon B. Johnson signed [amendments to] the Social Security Act creating Medicare, Medicaid and GME funding, there was a quote noting that education improves quality of care and that its costs should be borne partially by the hospital insurance program until communities bear that cost in another way.
For a long time, we’ve relied heavily on federal subsidies for GME. When we developed a new internal medicine program in a vulnerable area of Southern California, it cost $2 million to $3 million to start — before reimbursement began. We faced a significant funding gap.
Fortunately, the community stepped up. The Raugh Family Foundation provided a multimillion-dollar grant as seed funding to launch the residency program. That’s what we need more of — community involvement and philanthropy to support training programs in high-need areas.
