Financing graduate medical education in primary care: options for change

The current mechanisms of graduate medical education (GME) financing favor inpatient and procedural care, making the support of primary care programs difficult, as these residencies are oriented toward outpatient evaluation and management. Criteria for evaluating proposals that aim to improve the financial support of primary care programs include the financial, administrative, and educational implications of the options as well as the views of interested stakeholders. Other sources of funding for primary care GME are changes in existing Medicare payments; increased categorical GME funding, ambulatory payment, and grants; commitments from future employers; and redistribution of current funds. Alternatives for spending these funds to aid primary care programs include dividing the sources in three ways: on a per-resident basis, by competitive grants, or by incentives for primary care education. An analysis of the alternatives for changing GME financing shows that several solutions will be needed simultaneously.