Primary Care Physicians: Financing Their Graduate Medical Education in Ambulatory Settings. A Report of a Study by a Committee of the Institute of Medicine, Division of Health Care Services

Because of changes in the health care system, the hospital has become less suitable as the primary focus of graduate medical education for primary care physicians. However, the current system of financing health care education and services makes it difficult to accomplish the needed shift to training in primary care ambulatory settings. This book suggests ways of lowering financial barriers to primary care training in ambulatory settings. This report is the result of a study by a committee charged with developing strategies for financing graduate medical education (GME) for primary care (general internal medicine, general pediatrics, and family practice) practitioners in ambulatory settings. Historically, systems of financing for most physicians in GME have favored inpatient and specialty education, making it difficult for primary care practitioner students to receive increased training in ambulatory settings. The study consisted of two meetings; at the first meeting, a program for a workshop was developed. At the second meeting, the workshop was implemented (April 18-19, 1989), with over 50 participants. The resulting recommendations are presented in the report's three chapters. The first, "Concerns about Primary Care Residency Training," outlines concerns about the production of primary care physicians to meet the nation's future requirements. Chapter 2 is titled "Costs and Revenues for Primary Care Residencies in Ambulatory Settings." Chapter 3, "Options and Recommendations for Financing Graduate Medical Education for Primary Care Physicians in Ambulatory Care Settings," lays out the committee's recommendations and discusses existing barriers to financing and criteria for evaluating policy options. Appendix A contains the workshop program and proceedings. Appendix B contains four additional papers commissioned by the group: "The Cost of Graduate Medical Education in Outpatient Settings" (Judith R. Lave); "Financing of Medical and Graduate Medical Education: Issues in Primary Care Education Support" (Ruth S. Hanft); "Financing Graduate Medical Education in Primary Care: Options for Change (Sandra C. Peinado and John M. Eisenberg); and "Financing Primary Care Residency Training: Examples and Lessons from Successful Programs" (Robert A. Walkington). (JB) By A Committee Of The Institute Of Medicine, Division Of Health Care Services. On Cover: Primary Care Physicians, Financing Their Gme In Ambulatory Settings. The Institute Of Medicine Created The Committee To Study Strategies For Supporting Graduate Medical Education For Primary Care Physicians In Ambulatory Settings To Improve The Effectiveness And Efficiency Of Primary Care. Bibliography: P. 261-265.