September 6-7, 2006, Gaithersburg, Maryland
The Council of Graduate Medical Education (COGME) convened in the Montgomery Room in the Hilton Washington, DC North/Gaithersburg at 8:30 am on September 6th, 2006.
Russell G. Robertson, M.D., Acting Chair
Denise Cora-Bramble, M.D., M.B.A, Member
Joseph Hobbs, M.D., Member
Mark A. Kelly, M.D., Member
Rebecca M. Minter, M.D., Member
Thomas J. Nasca, M.D., M.A.C.P., Member
Angela D. Nossett, M.S., Member
Robert L. Phillips, Jr., M.D., M.S.P.H., Member
Kendall Reed, D.O.,F.A.C.O.S., F.A.C.S., Member
Earl J. Reisdorff, M.D., Member
Vicki L. Seltzer, M.D., Member
Jason C. Shu, M.D., Member
William L. Thomas, M.D., F.A.C.P., Member
Leana S. Wen, M.S., B.S., Member
Barbara J, Chang, M.D., M.A., Designee of the Department of Veterans Affairs
Tzvi M. Hefter, Designee of the Administrator, Centers for Medicare and Medicaid Services
Designee of the Acting Assistant Secretary of Health
Henry Lopez, Acting Director, Division of Medicine and Dentistry
Jerald M. Katzoff, Executive Secretary
Howard Davis, Ph.D.
Hyoun-Kyoung Higgerson, Ph.D.
Dr. Robertson, Acting Chair, welcomed both the returning and new COGME members. He introduced the new members: Dr. Denise Cora-Bramble, Dr. Joseph Hobbs; Dr. Mark A. Kelly; Dr. Thomas J. Nasca; Robert L. Phillips, Jr.; Dr. Kendall Reed; Dr. Vicki L. Seltzer; Dr. Jason C. Shu; Dr. William L. Thomas; Lena S. Wen.
Mr. Steven Pelovitz, BHPr Deputy Associate Administrator, representing A. Michelle Snyder, Associate Administrator, BHPr, conveyed her welcome COGME members and noted the importance of the Councils work and recommendations. Mr. Pelovitz described current objectives and plans for both HRSA and BHPr and noted recent changes in senior management at the Bureau
Henry Lopez, Acting Director, Division of Medicine and Dentistry (DMD), welcomed COGME members on behalf of the Division. He noted the importance of the Council’s work and recommendations. He reviewed recent staff changes in DMD and also recognized COGME staff members, commending them for their efforts in bringing the meeting to fruition.
Executive Secretary’s Report
Mr. Katzoff, after welcoming the COGME members, noted the layout of the agenda book, explained the report writing process, and emphasized the importance of member participation in writing the reports.
Election of New Chair
COGME membership, by acclamation, elected Dr. Russell G. Robertson as Chair and Dr. Robert L. Phillips, Jr. as Vice-chair.
Orientation of New Members
Mr. Katzoff oriented the ten new members to the purpose of COGME, its legislative mandate, its recent history of being continued through appropriation language, and the mandated entities to which Reports are sent. He also presented the process which will be used to develop the reports on the two current topical areas selected by COGME.
The papers elicited a discussion of a range of cogent issues. Included among these issues was the belief that national service would not address physician geographical or specialty maldistribution. Many areas are currently experiencing shortage of physician specialists, an issue that would not be addressed by mandatory service. The consensus was that mandatory service was neither desirable nor feasible. However, there was an overriding theme; those who practice medicine have a social obligation to provide medical care to all persons, regardless of their social-income status.
These papers elicited discussion of a number of compelling issues and concerns, some of which are illustrated by the following themes: The influence of external factors, such as the Residency Review Committees (RRC), which may encumber changes; accountability for monies allocated for GME; appropriate use of Indirect Medical Education (IME) funds; achieving a balance between program and institutional accreditation; making the graduate medical educational training component correspond to alternate health care delivery systems; the fragile commitment that many residency programs have toward medical education, relying instead upon using residents for service delivery.
Breakout of Council Members into Two Writing Groups
The chair and members were identified to participate in two groups. Each group was charged with preparing a draft outline and recommendations for each report. The chair of each writing group was to identify member(s) responsible for drafting a narrative for each section contained in the outlines.
Report to Council on Draft Recommendations, Proposed Outline, and List of Members to Draft Each Section of the Two Reports
The chair of each writing group reported to the plenary meeting success in produced a draft outline, recommendations, and identifying members responsible for developing the appropriate narratives for each topical subject.
National Physician Service Writing Group
The writing group entitled its report as: New Paradigms for Physician Service in Improving Access to Healthcare
The following members composed the writing group dealing with the national service physicians: Earl Reisdorff (Chair), Angela Nossett, Lena Wen, and William Thomas.
Tentative recommendations are as follows:
Graduate Medical Education Flexibility Writing Group
The writing group entitled its report as: Flexibility in GME
The following members composed the writing group dealing with GME flexibility: Dr. Barbara Chang (Chair), Dr. Rebecca Minter, Dr. Mark Kelly, Dr. Vicki Seltzer, Dr. Kendall Reed, Dr. Robert Phillips, Jr., Dr. Joseph Hobbs, , Dr. Denice Cora-Bramble,
Dr. Thomas Nasca, and Ms. Renate Rockwell representing Tzvi Hefter of CMS.
Tentative recommendations are as follows:
Ms. Holly Mulvey of the American Academy of Pediatrics stated that the Academy, prompted by the COGME presentation in its September 2005 meeting regarding reentry of physicians into the workforce, was implementing an initiative to bring together many organizations and societies to further study the issue with the goal of facilitating physician reentry into the workforce.
Dr. Steven Shannon, President of the Association of American Colleges of Osteopathic Medicine, expressed his wish on behalf of his Association to have an opportunity to review and make comments on COGME report drafts prior to publication.