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Summary of Ninth Report

Graduate Medical Education Consortia:
Changing the Governance of Graduate Medical Education to Achieve Physician Workforce Objectives

June 1997

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Executive Summary & Recommendations

The United States faces an overabundance of physicians that will extend well into the next century, most of the excess being accounted for by certain categories of specialists and subspecialists. At the same time, policy makers, the managed care industry and leaders of academic medicine express concern that the traditional medical education system is not providing all the competencies necessary for the effective practice of medicine in the modern health care market place. More training in ambulatory care, more community-based physician role models and more interaction with other health care professionals are increasingly advocated.

The physician workforce is the product of a large and heterogeneous enterprise-an enterprise that has been slow to change in the past and which has yet to achieve consensus on how to reshape itself for the future. At the core of this heterogeneity is a broad and complex mission involving health care, biomedical research and medical education. More than mission complexity, however, reform is hampered by the absence of an integrated system of governance for medical education.

Fragmented governance is a particular problem at the level of graduate medical education, where hospital executives, clinical service chiefs, medical school deans and academic department chairs often represent different constituencies, and have to respond to a confusing plethora of accrediting and certifying bodies and other professional organizations. The increasing emphasis on education in ambulatory care settings, puts further stress on the present system of governance.

In order to teach those competencies necessary in a managed care world and to contain health care costs, multiple health care provider and planning organizations must be involved. The day when medical education could be confined to one entity, the university hospital or its surrogate, has passed. Once said, then new systems for addressing physician workforce issues, for the measurement and maintenance of educational quality, for the administration of educational programs, for allowing input from the various stakeholders, and providing for an equitable distribution of resources are both reasonable and necessary. In principle, the consortium concept fulfills this need.

Mutual partnerships and collaborations have long been an essential element for successful medical education, and consortia provide a means of perpetuating, and where necessary expanding, such interactions in the future. Consortia presently occupy the middle portion of the spectrum of entities involved in graduate medical education, bridging the territory between traditional affiliations and acquisitions or mergers. Consortia differ substantially from affiliations, which imply no formal organization or collaboration beyond that stipulated by the agreement, are typically bilateral (rather than multilateral), and are usually negotiated independently with each partner (rather than collectively among a broader range of partners). Consortia also differ substantially from acquisitions or mergers, which lead to the formation of a single organization (rather than a cooperative alliance of institutions with shared interests) and imply a pooling of all assets and a surrender of fiduciary control (neither of which occurs during the formation of a consortium).

Two recent national surveys of graduate medical education consortia conducted by the Association of American Medical Colleges in conjunction with the Maine Medical Center in 1993 (MMC/ AAMC Survey) and the Center for the Health Professions at the University of California, San Francisco in 1995 (AAMC/CHP Survey) have indicated that consortia do provide a framework within which medical education, especially graduate medical education, can be critically examined and an equitable forum within which all interested constituencies can participate. Indeed, existing consortia can point to enhanced working relations and management efficiencies with justifiable pride.

Achievements: Improved Administration Working Relations

Internal Relations Teaching hospitals Medical school(s) and hospitals	95% 90%
External Relations Community physicians 1 GME program sponsors/payers Regulatory agencies Managed care organizations	53% 1, 67% 2 72% 43% 15%