Graduate medical education grants are given to meet the nation’s health needs. Direct and indirect GME funding is intended to support resident reimbursement and the higher costs of supporting a teaching program.
With the growing diverse population in the United States, there is an urgent need to train a modern health care workforce. They are required to attain the skills that can provide care in a rapidly evolving environment. Physicians develop such skills from graduate medical education (GME), a period of residency and fellowship training undertaken after graduation. GME is a vital pipeline, and to cover the costs; grants are offered.
Graduate Medical Education Grants – What Is GME and How Is It Funded?
Graduate Medical Education (GME) comprises all the training that medical students receive after graduation to be a practicing physician. In other words, GME means fellowship and residency.
GME grants are available through multiple mechanisms, including federal, state, and other private entities. The federal government is the largest and the primary funding source for GME funding, and its funds flow through Direct GME (DGME) and Indirect Medical Education (IME). Both DGME and IME grants are controlled by the Centers for Medicare and Medicaid Services (CMS).
Direct Graduate Medical Education Grants (DGME) helps to pay for direct teaching costs, including salaries, residents, faculty, and benefits. Indirect Graduate Medical Education (IME) grants are utilized for technology updates, teaching hospital compensation, handling a population that tends to be sicker, and additional residency support staff. For more information, visit https://www.aafp.org/dam/AAFP/documents/events/rps_pdw/handouts/res-57-sanner.pdf.
Graduate Medical Education Grants – Federal Role in GME
The federal government makes notable investments in GME grants through Medicare and Medicaid programs. These programs are run by the Centers for Medicare & Medicaid Services (CMS) administered by the U.S. Department of Health and Human Services (HHS). HHS’s Health Resources and Services Administration (HRSA) supports primary care training in outpatient facilities by training medical residents at the Department of Veterans Affairs (VA) and Department of Defense (DOD) facilities. It also assists in rural GME program development and training in children’s hospitals.
The American Association of Medical Colleges (AAMC) is a private and nonprofit organization that represents U.S. accredited medical schools and teaching hospitals. It emphasis physician supply and the use of new care models to avert shortages.
Federal Support for Graduate Medical Education
The federal government supports the health workforce and the physician workforce through several programs.
Medicare is the largest federal program of GME that supports and enhances the quality of educational activities. The Medicare program covers health care services for qualified beneficiaries. Medicare provides GME payments based on factors, including a teaching hospital’s full-time equivalent (FTE) residents.
However, Medicare GME funding is not bound to a specific resident; rather, multiple residents may occupy one FTE. For more information, visit https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495035/.
Medicaid is a joint federal-state program and provides the second-largest GME support. The Medicaid States follow federal rules to receive federal matching funds; however, they can design and administer their versions of Medicaid.
AAMC and GAO detail information about the professions eligible for Medicaid GME payments. Most states support training programs for physician residents and for health professions, such as nurses and practitioners, dentists, physician assistants, podiatrists, and allied health professionals.
Department of Veterans Affairs (VA)
Training health care professionals, including physicians, is part of the VA’s statutory mission. The aim is to provide an adequate supply of health professionals for the overall VA’s health system.
Generally, each year, about 45,000 individual physician residents receive clinical training by rotating through around 11,000 funded physician FTE residency positions at VA medical facilities. For more information, visit https://www.va.gov/OAA/Expanding_GME.asp.
Health Resources and Services Administration (HRSA)
The HRSA supports GME through two programs: The children’s Hospital GME Program (CHGME) and the Teaching Health Center GME (THCGME). The CHGME program offers training to pediatric subspecialists and general pediatricians, while the THCGME provides training to residents in outpatient settings in psychiatry and primary care.
In addition to these programs, HRSA receives appropriations to support GME related programs. The first program receives funds upto $25 million to offer grants to public institutions of higher education in states to expand or support GME.
The second program of HRSA receives around $10 million to assist the Rural Residency Development program, which includes funding to rural hospitals for the development of rural training tracks.
Department of Defense (DOD)
The Department of Defense (DOD) assists residents who have acquired a uniformed service obligation through a DOD physician training program. The Uniformed Services University of the Health Sciences (USUHS) and the Health Profession Scholarship Program are some examples.
The USUHS students receive the pay and benefits of an officer. Under the Health Profession Scholarship Program, DOD pays tuition and fees, along with a monthly stipend for students registered in civilian medical schools.
The federal government offers many programs that support graduate medical education grants. Various departments across the federal government operate these programs, and each of them has its own stated program goals.
The purpose of graduate medical education grants is to support a more targeted, performance-based investment in our future healthcare workforce training. It helps build social infrastructure that encourages health equity, provides universal health coverage, and decreases the financial burden of medical education.