Minutes
of Meeting, May 9, 2008
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.
Members Present
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.
Welcome
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.
Next Steps
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.
Adjournment
The Council adjourned
2:30 P.M.
