A proposed change to Medicaid rates paid to North Carolina hospitals would eliminate Graduate Medical Education payments to our state’s teaching hospitals, risking severe damage to the model used to produce fully trained physicians who stay in North Carolina. It’s a bad idea.
“GME” refers to the intense medical training that is required after a physician receives a doctor of medicine or doctor of osteopathic medicine degree. This training includes the internship, residency, sub-specialty and fellowship programs that lead to board certification and state licensure, which are necessary for the independent practice of medicine. To support this essential training for physicians, hospitals rely on GME funding from multiple payers, including the state, which provides money through the current Medicaid rate structure.
According to the Cecil G. Sheps Center for Health Services Research, the cost to train a single resident physician in North Carolina is about $143,000 per year. This cost, which is carried by hospitals with training programs, includes the nominal salaries for the resident physicians and fellows, mandatory faculty oversight and direction and coordination of the programs. The elimination of Medicaid GME funding would cut the resources available to Vidant Medical Center for physician training by nearly $5 million.
Vidant Medical Center is a tertiary referral center that provides acute, intermediate, rehabilitation and outpatient health services to more than 1.4 million people in 29 counties. It is a major physician training site and serves as the teaching hospital for the Brody School of Medicine at East Carolina University. This clinical education reflects our commitment to help supply physicians and other health care professionals to the communities we serve. However, with reimbursement from all payers diminishing, we must rely on external sources of GME funding such as Medicaid to support the cost of clinical education.
There are 404 resident physicians employed at Vidant Medical Center: 47 are training in internal medicine, 36 in family medicine, 36 in emergency medicine and 32 in pediatrics. The remaining resident physicians are training in other medical specialties equally important to Eastern North Carolina, such as psychiatry and OB/GYN. A significant number receiving their clinical education at Vidant Medical Center are training in primary care.
Like many states, North Carolina has a shortage of primary care physicians, especially in rural areas. Medical schools around the state have responded by establishing programs to address those needs. The Brody School of Medicine, in particular, was created to increase the supply of primary care physicians serving the state.
Brody and North Carolina’s other medical schools rely on clinical sites like Vidant Medical Center to provide essential training opportunities for North Carolina medical students, the majority of whom stay in North Carolina to practice. Reducing the funding used to support the considerable costs of physician training threatens the ability of Vidant Medical Center and other teaching hospitals to continue this crucial work. Without physician training sites, North Carolina could lose its medical students (and physician pipeline) to other states, many of which are substantially increasing their funding of physician training.
Eliminating state funding for GME is a shortsighted budget fix. The federal government matches every dollar in state funding 2-to-1, which means North Carolina teaching hospitals could have $40 million less for their GME programs. Without adequate opportunities for post-medical school clinical education, North Carolina’s medical students will be forced to go out of state for training, and, ultimately, to practice medicine.
We must protect state GME funding so that North Carolina can keep our next generation of physicians in our state and in Eastern North Carolina.
Herb Garrison, M.D., is associate dean for Graduate Medical Education at the Brody School of Medicine at East Carolina University and Vidant Medical Center.