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Department of Health and Human Services
Council on Graduate Medical Education
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Minutes of Meeting

September 6-7, 2001, Bethesda, Maryland

 Minutes of Meeting, September 6-7, 2001

The Council on Graduate Medical Education (COGME) met at 8:30 a.m. in the Versailles I Room, of the Holiday Inn, Bethesda, Maryland. Due to technical difficulties, the meeting began at 9:10 a.m. Dr. Carl J. Getto, COGME Chair, presided. The meeting adjourned at 4:05 p.m. It reconvened the next morning, September 7, at 8 a.m. in the same room and adjourned at 11:15 a.m. that day.

Members Present:
CARL J. GETTO, M.D., Chair
JO IVEY BOUFFORD, M.D., Vice Chair
REGINA M. BENJAMIN, M.D., M.B.A, Member
F. MARIAN BISHOP, Ph.D., M.S.P.H., Member
WILLIAM CHING, Medical Student, Member
ALLEN IRWIN HYMAN, M.D., FCCM, Member
ROBERT L. JOHNSON, M.D., Member
LUCY MONTALVO, M.D., M.P.H., Member
JERRY ALAN ROYER, M.D., M.B.A., Member
SUSAN SCHOOLEY, M.D., Member
DONALD C. THOMAS III, M.D., Member
STEPHANIE H. PINCUS, M.D., M.B.A., Member
HUMPHREY TAYLOR, Member
DOUGLAS L. WOOD, D.O., Ph.D., Member
TZVI M. HEFTER, Designee of the Health Care Financing Administration

Also Present:
CRYSTAL CLARK, M.D., M..P.H., Acting Executive Secretary
JERILYN K. GLASS, M.D., Ph.D., Acting Deputy Executive Secretary
ELIZABETH M. DUKE, Ph.D., Acting Administrator, HRSA
SAM SHEKAR, M.D., M.P.H., Associate Administrator for Health Professions
GLORIA HOLLAND, Ph.D., Former Designee of the Department of Veterans' Affairs

Welcome and Announcements:
The meeting was opened by Dr. Getto who announced that the Proceedings of the GME Financing Stakeholders Meeting had just been published. He introduced Dr. Sam Shekar, Associate Administrator for Health Professions who in turn introduced Elizabeth Duke, HRSA's Acting Administrator. Dr. Duke gave welcoming remarks to COGME members and information on HRSA activities. Dr. Getto announced that the focus of the day would be work on the draft copy of COGME's final report prepared by COGME staff.

Discussion of Final Report:
Dr. Jerilyn Glass and Dr. Richard Diamond joined the Council for discussion of the report. Council members praised the draft report overall, but suggested some content and format changes. Among the recommendations were inclusion of a historical perspective behind the creation of the Council and an introduction explaining COGME's distinctiveness as an advisory committee. The discussion included mention that there should be documentation of COGME's role in raising issues that have affected government and private sector policy and actions; some of COGME's groundbreaking activities, such as its collaboration with the National Advisory Council on Nurse Education and Practice last year; and its contributions, such as the development of competencies by the Accreditation Council for Graduate Medical Education in response to COGME recommendations. Mr. Jerald Katzoff provided a historical perspective to members on events leading up to COGME's creation. The Council favored inclusion of a timeline with COGME reports matched with temporal outside influences.

Content topics such as "110: 50/50," minority physicians and diversity, cultural competencies, international medical graduates, women in medicine, GME financing, underinsurance, and the changing health care environment were discussed. Members considered a possible COGME role with regard to undergraduate and continuing medical education. The purpose of an executive summary was reviewed. Editorial suggestions were made including shortening sentences and paragraphs. It was recommended that the report, due to Congress by April 1, have the title, "2002 Summary Report."

Dr. Getto summarized the day as having raised two distinct groups of issues: 1) issues raised in prior COGME published reports that still need further attention and analysis, such as workforce, geographic distribution, minorities, and GME financing; and 2) new issues that COGME wants to address in future meetings such as workforce substitutability, working conditions, and quality of graduate medical education. Members suggested additional issues in each group.

Public comment at end of first day:
Holly Mulvey from the American Academy of Pediatrics and Perry Pugno from the American Academy of Family Physicians mentioned important contributions made by COGME. Ethan Jewett from the American Academy of Pediatrics urged inclusion of the topic of specialties and subspecialties in future COGME deliberations.

At 8:00 a.m. the following morning the meeting resumed: 
Dr. Getto introduced Ed Salsberg, Director, Center for Workforce Studies, State University of New York at Albany, whose presentation was "Measuring the Adequacy of the Physician Supply." Mr. Salsberg discussed key physician workforce issues, the results of the 2000 resident exit survey in New York and California, and both the benefits and shortcomings of market-based approaches. He concluded his presentation by stating that the nation needs to do a better job of assessing current and future supply and demand by specialty. There is also a need to reassess reimbursement methodologies to reduce the discrepancy between primary care and non-primary care specialties.

Dr. Getto introduced the second speaker, Claudia Munoz, M.P.H, Research Associate, Center for California Health Workforce Studies, University of California, San Francisco. In her presentation, "Strategies for Improving the Diversity of the Health Professions," she discussed the University of California Regent's policy that prevents the consideration of racial or ethnic group when looking at admissions and a similar policy, the Texas Hopwood Decision. She pointed out that during the past ten years there has been a large decrease in underrepresented minority and other applications to allopathic medical schools. From the early 1990's until 1997, there was a surge in minority matriculants in osteopathic medical schools and then the numbers declined. Ms. Munoz pointed out the need to recruit ethnic and racial minorities from underserved populations who want to go back and serve their own communities.

Dr. Getto opened the discussion on priorities for future COGME activities. The group decided that under the category of workforce, they wanted to look at specialty and sub-specialty shortages, substitutability, the "110/50:50" recommendation, and workforce models. Additional topics of interest were workforce diversity, the related topic of cultural competency, and possibly further work in the area of GME financing. The Council decided that the December meeting should feature a panel of speakers on different health care delivery systems because workforce planning requires the context of a particular system. COGME was very interested in having speakers describe the systems of the Department of Defense and the Department of Veterans Affairs. Three workgroups which will convened at the December meeting: Diversity, GME Financing, and Workforce. COGME staff will provide literature on substitutability for the Workforce Workgroup to review prior to the meeting. COGME will review a draft 2002 Summary Report at the meeting which will incorporate suggestions made by Council members during the preceding months.

Public comment at end of second day:
Carol Jennings from the American Academy of Nurse Practitioners brought a statement from her organization regarding possible collaboration with COGME. Sunny Yoder from the Association of American Medical Colleges and Frank Simon from the American Medical Association both asked for further clarification regarding COGME's earlier discussion on models. Molly Hicks from the American Academy of Pediatrics said she would welcome further COGME discussion on critical issues surrounding reauthorization of Title VII as well as outreach to the specialty community active in supporting graduate medical education programs.

The meeting adjourned at 11:15 a.m.