May 9, 2008, Rockville, Maryland
The Council of Graduate Medical Education (COGME) convened in the Hilton Washington D.C. Rockville Executive Meeting Center at 8:30 am May 9, 2008.
Russell G. Robertson, M.D., Chairman
Robert L. Phillips, M.D., M.S.P.H., Vice Chair
Joseph Hobbs, M.D.
Linda Johnson, M.D.
Thomas E. Keane, M.D.
Mark A. Kelley, M.D.
Spencer G. Nabors, M.D. M.P.H., M.A.
Kendall Reed, D.O., F.A.C.O.S., F.A.C.S.
Sheldon M. Retchin, M.D. M.S.P.H.
Jason C. Shu, M.D.
HRSA Staff Members:
Jerry Katzoff, Executive Secretary
Marilyn Biviano, M.D.
Dr. Robertson, Chair, welcomed the COGME members.
Executive Secretary’s Report
Mr. Katzoff gave his report, summarizing the follow-up activities that occurred in response to the recommendations that the Council had made in its meeting of September 2007. Activities included having the May 8 “all advisory meeting” composed of COGME, the Advisory Committee on Primary Care Medicine and dentistry, the Committee of Interdisciplinary Community Based linkages, and the National Advisory Council of Nursing Education and Practice. Other activities involved planning for the current meeting
Presentations to the Council
During the day, the Council members heard presentations given by Edward Salsberg, Senior Associate Vice President of the Association of American Medical Colleges, Dr. Sean Nicolson, Professor of Economics at Cornell University, and Dr. Charles Roehrig, Vice President of Altarum Institute.
Each presented on issues concerning physician specialty choice.
Mr. Salsberg’s presentation covered specialty choice trends, factors that influence specialty choice, signals that medical school students receive from the marketplace, and ways to encourage primary care specialty choice. Factors presented as relating to specialty choice included mentors and exposure, debt, lifestyle, personality, gender, and length of training. Mr. Salsberg’s recommendations for encouraging primary care specialty choice included addressing the income gap for primary care, marketing primary care as lifestyle friendly, redesigning the primary care delivery system, educating and training teams and encouraging interprofessional practice models, and effecting better reimbursement for training in ambulatory settings.
Dr, Nicholson’s presentation focused on medical career choices and rates of return. He traced the Federal involvement on issues related to the numbers and/or specialty mix of physicians, and presented arguments for government involvement in these issues. He detailed the findings of past studies which indicated that prospective physicians respond to changes in expected earnings, although the magnitude of the responsiveness varies. He concluded that, while not the primary factor in influencing specialty choice, “money does matter”, and prospective physicians are more likely to choose high income specialties.
Dr. Roehrig described a model that he produced under contract to the Bureau of Health Professions in the late 1980s. The “Specialty Distribution Model” was designed to produce “what-if “ specialty distribution forecasts based on changes in factors such as Medicare GME reimbursement policies, policies affecting the entrance of IMG physicians, resident stipends, required length of residency training by specialty, and expected practice incomes by specialty. Dr. Roehrig indicated that with additional resources, he would be able “model” changes to the physician specialty distribution emanating from different policy relevant scenarios. In this effort, he would utilize the most recent information available on “income elasticity of specialty choice” i.e., the percentage change in the specialty selected based on a one percent change in specialty income.
Following the three presentations, lively discussion ensued. As each of the three presentations indicated that income is not the primary influence on specialty choice, the Council members concluded that its next report must be broader then just a focus on reimbursement for influencing specialty choice. The Council supported Mr. Katzoff’s explorations to ascertain if Bureau funding is available for extending the modeling work as embedded in the Specialty Distribution Model, and if so, in developing a procurement request. In the short term, the Council members agreed to send to Mr. Katzoff possible policy scenarios that could be used in formulating a procurement request for continued modeling/analytical work in this area.
The Council adjourned 2:30 P.M.