Graduate Medical Education (GME) is a complex issue that has loomed over medicine for some time. Cuts to GME funding pose significant obstacles to meeting the ever-growing demands for health care services. While several medical schools are expanding enrollment to meet increasing demand, the American Association of Medical Colleges (AAMC) expects a shortage of nearly 63,000 U.S. physicians this year, and this number is predicted to increase to 130,000 physicians across all specialties by 2024.

In order to understand this crucial issue and its impact on U.S. health care, the House Energy and Commerce Committee asked stakeholders, including the ACC, to provide feedback on the current GME situation and the future of medical training.

In a letter to the Committee, the ACC laid out the following considerations:

• Attention must be given to multi-disciplinary management of chronic diseases, such as cardiovascular disease, that cross multiple medical specialties.
• Health care delivery systems and regional and population-based needs should be evaluated.
• Cutting-edge training for America’s health care workforce is necessary given the complex diagnostic and management algorithms needed to combat cardiovascular disease and related conditions.
• There must be adequate funding for academic teaching hospitals in order to ensure the continuation of the critical services they provide, especially to vulnerable populations. Training for outpatient and preventative care services is also crucial.

The ACC stressed that by 2030, more than 40 percent of American adults are expected to have some form of cardiovascular disease. Given this alarming statistic, funding for multispecialty management of chronic, noncommunicable diseases should “rise to the top.” At the same time, the important roles played by primary care physicians, endocrinologists, cardiologists and others must be recognized.

The ACC also pointed out that a recent Institute of Medicine report on GME is a step in the right direction, but it fails to address the projected shortfall the nation’s medical workforce. “Radically overhauling support for GME and diverting even more funding from specialty training in the midst of a projected cardiovascular workforce shortage could pose threats to the quality, high-value care of increasing numbers of patients with cardiovascular disease most at risk who need both primary and specialty care services,” the College said.

The ACC informed the Committee that it is in alignment with the workforce recommendations of the AAMC. Furthermore, the College acknowledges GME-related legislation from the 113th Congress, including the Training Tomorrow’s Doctors Today Act (formerly H.R. 1201) and the Resident Physician Shortage Reduction Act (formerly H.R. 1180), both of which would lift the cap on Medicare-funded residency positions and make much-needed improvements to bolster the physician pipeline. “We encourage the reintroduction of legislation with similar aims in the 114^th Congress, and stand ready to work with interested members on both sides of the aisle,” concluded the ACC.

Keywords: Algorithms, Cardiovascular Diseases, Chronic Disease, Education, Medical, Graduate, National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division, Internship and Residency, Medicare, Medicine, Physicians, Physicians, Primary Care, Schools, Medical, United States, Vulnerable Populations

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