PRP157: Shaking off Dust: Mixed methods analysis of policy barriers to GME reform after the IOM report of 2014

Sarah Hemeida, MD, MPH; Mannat Singh, MPA, MPA; Lauren Hughes, MD, MPH, MSc, FAAFP


Context: Despite substantiated calls for reform of the financing and governance of Graduate Medical Education (GME) in the US, little has changed. Taxpayers invest over 15 billion dollars annually on GME, however physician shortages and maldistributions persist. The Institute of Medicine (IOM) spent over a year studying the funding of GME, resulting in their report and recommendations which have largely failed implementation. The COVID-19 pandemic has again revealed inadequacies of health care organization, financing, delivery, and workforce. In the aftermath of COVID-19, there will be a narrow political window to educate policy makers on the need for substantial GME reform. Objective: Identify the multifactorial policy barriers to implementation of the 2014 IOM report recommendations on GME governance and finance to inform educational and advocacy efforts for GME reform. Study Design and Analysis: Mixed methods: A) Literature review of attempts, recommendations for, and barriers to GME reform since 2014. This policy-informed review will include peer-reviewed and “grey” literature using a rapid review approach. B) A 50-state policy scan to identify state-level statutes which codify legislative reforms to the governance and financing of GME. C) Up to 25 key informant interviews of GME policy experts and stakeholders, using convenience and snowball sampling. Setting or Dataset: US State level statutes and codes using “Municode” source. Population Studied: national GME policy experts and stakeholders; state statutes. Intervention/Instrument: Search terms for rapid review and policy scan will be collated, pretested in limited reviews, and implemented. The key informant interview instrument will be developed, pretested, and implemented. Outcome Measures: Key themes from the rapid review and key informant interviews will be elucidated using inductive reasoning. The 50-state policy scan outcomes will include binary variables: legislative language related to GME finance (Y/N); legislative language related to GME governance (Y/N); Medicaid dollars utilized for state GME (Y/N). Results: Not yet resulted. Expected Outcomes: Anticipate multifactorial policy barriers to GME reform, including challenges in political will among state legislators; financial barriers related to redistribution of indirect GME funds away from teaching hospitals; and historical and ongoing lack of transparency in how GME funds are utilized by sponsoring institutions.

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