Percentages of consortia reporting increases in the production of
physicians of the types specified. AAMC/CHP Survey - left Column: 1consortia
in operation for at least two years, 2 consortia in operation
for less than two years. MMC/AAMC Survey - right column. NA = not available.
Source: MMC/AAMC & AAMC/CHP Surveys
Given this mixed performance, the question arises whether the widespread
adoption of consortia would be an appropriate vehicle for reorganizing
the presently fragmented graduate medical education system. In thinking
about this, it is important to emphasize that the development of consortia
is not a goal unto itself. Rather, it is a means to an end. There is
no inherent linkage between the concept of educational consortia and
either the quality of medical education or physician workforce reform.
One can exist without the other, and one does not necessarily result
in the other.
Nonetheless, COGME believes that the consortium concept provides the
inherent organizational flexibility needed to draw upon the expertise
of the broad and diverse group of stakeholders that, collectively, will
be necessary to reorganize medical education. Further, COGME believes
that appropriately structured consortia would provide the foundation
upon which substantive physician workforce reform could take place.
Educational consortia are presently burdened with expectations and
hobbled by the lack of real authority. It is unrealistic to expect consortia
to improve the structure and governance of medical education and to
align physician training with health care needs unless they are appropriately
structured and have access to the resources to do so. In seeking to
define how educational consortia could best serve as both a catalyst
and a unifying force in reorganizing medical education, this report
addresses questions of organizational structure, authority and responsibility,
examines funding mechanisms and how educational resources should be
distributed, and provides policy makers with a blueprint for action.
COGME believes that consortia should include medical schools, teaching
hospitals and community training sites, and promote an interdisciplinary
approach to health care delivery. To be effective, COGME believes that
consortia must have local sponsorship authority and responsibility for
graduate medical education, and access to the financial resources necessary
to reform graduate medical education.
COGME supports a "shared responsibility" approach to funding graduate
medical education, in which all payers of health care participate, and
proposes that consortia be eligible to receive graduate medical education
payments. COGME also proposes that graduate medical education payments
be disbursed to training sites on the basis of actual expenses incurred.
Finally, COGME advocates funding a series of consortia demonstration
projects, establishing an appropriately constituted body to oversee
the development of national standards for educational consortia, and
enacting health care reimbursement incentives to promote consortium
development.
Defining Educational
& Workforce Outcomes
Organizations function best when they have a comprehensive vision.
In the case of educational consortia, this vision should include a mission
that is anchored by a commitment to providing each and every graduate
with all necessary career-specific competencies. However, a focus on
individual competency is insufficient: Consortia should also entertain
a broader view of competence, one whose frame of reference is the physician
workforce as a whole. Simply put, "workforce competence" requires that
the overall process of medical education be organized within the framework
of societal needs and expectations.
Consortia must recognize the need for a national workforce that, collectively,
has relevant practice, research and educational expertise. Consortia
must also recognize the need for a rationally distributed regional workforce
with appropriate generalist and subspecialist practice skills. And consortia
must also be responsive to social and political needs, championing the
need for a physician workforce that reflects the diversity of the population
from which it is drawn. Thus, although education should be a consortium's
primary priority, its product must also be able to meet present and
future health care needs.
Consortia, no less than any other academic constituency, will be asked
to defend their "education template". This does not mean that consortia
have to reinvent the entire process of medical education, assume all
(or even most) of the responsibilities of their individual members,
or usurp the prerogatives of accrediting or licensing bodies. Rather,
consortia should function as umbrellas under which medical education
is reorganized, acting as guardians of the educational environment and
ensuring that their product has societal relevance. In these matters
they should act for and on behalf of their members, already having organized
and catalyzed the necessary internal debate and already having led the
partnership to a collective, if not unitary, view of its future.
To do so effectively, consortia will need clearly delineated educational
and workforce goals, a strong sense of national and community health
care needs, and the inherent authority to better align education with
present and future physician workforce needs. Perhaps not surprisingly,
consortia with a mission that includes workforce reform as a priority,
have been more successful in enhancing generalist practice skills and
increasing the output of generalists than consortia that lack an explicit
commitment to reshaping the physician workforce.
Studies of existing consortia have also shown that management efficiencies
are achieved more commonly, and that the cost of administering educational
programs is less, in consortia with a mission that explicitly identifies
improving the administration of educational programs as an organizational
priority. A commitment to management excellence and an efficient administrative
infrastructure will almost certainly also be important determinants
of the ability of consortia to advance medical education and reform
the physician workforce.
With these considerations in mind, COGME recommends that consortia
should:
- Set explicit educational and workforce goals and evaluate their
accomplishments:
- Participate with local/regional health care agencies in determining
health resource needs; and
- Adapt programs in response to national, and state and community
health resource needs.
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