June 24, 2024
| The Honorable Ron Wyden | The Honorable Bob Menendez |
| Chair, Senate Finance Committee | 528 Hart Senate Office Building |
| 221 Dirksen Senate Office Building | Washington, DC 20510 |
| Washington, DC 20510 |
| The Honorable John Cornyn | The Honorable Bill Cassidy, MD |
| 517 Hart Senate Office Building | 455 Dirksen Senate Office Building |
| Washington, DC 20510 | Washington, DC 20510 |
| The Honorable Michael Bennet | The Honorable Thom Tillis |
| 261 Russell Senate Office Building | 113 Dirksen Senate Office Building |
| Washington, DC 20510 | Washington, DC 20510 |
| The Honorable Catherine Cortez Masto | The Honorable Marsha Blackburn |
| 520 Hart Senate Office Building | 357 Dirksen Senate Office Building |
| Washington, DC 20510 | Washington, DC 20510 |
Dear Chairman Wyden and Sens. Menendez, Cornyn, Cassidy, Bennet, Tillis, Cortez Masto, and Blackburn:
The nearly 50 undersigned members of the Graduate Medical Education Advocacy Coalition (GMEAC) appreciate the opportunity to respond to the Bipartisan Medicare Graduate Medical Education (GME) Working Group’s Draft Proposal Outline and Questions for Consideration. Our groups appreciate your bipartisan efforts to further expand GME, which would have a tremendous impact on the physicians and teaching hospitals our groups represent and the patients and communities our members serve.
The U.S. is facing a shortage of between 13,500 and 86,000 physicians by 2036 – in both primary care and specialty medicine.1 America’s medical schools, teaching health systems and hospitals, and their physician partners are doing their part by investing in physician and health care provider training and leading innovations in new care delivery models that are more efficient and include better use of technologies that improve patient access to care. Even with these efforts, however, physicians continue to report record levels of burnout, physician payments continue to fall well short of costs, and patients continue to struggle to access care. While numerous policy solutions are needed to sustain and bolster the physician workforce, increased Medicare support for GME is a key component to stabilizing the workforce expansion. With demand for physicians continuing to outpace supply as both the patient population and physician workforce age – it is critical now more than ever that Congress build on recent bipartisan efforts and invest in training more physicians.
The coalition is pleased to see that the working group is seeking ways to expand and improve Medicare-supported GME. Our organizations recognize the importance of this complex and consequential program, and submit the following responses to the working group:
Increase the Number of Medicare-Supported GME Positions:
The undersigned members of the coalition strongly support a robust increase in the number of Medicare-supported GME positions. As you know, Medicare offsets a portion of a teaching hospital’s training expenses through Direct Graduate Medical Education (DGME) payments. These expenses include resident stipends and benefits, faculty salaries and benefits, and allocated institutional overhead costs. This support, which is directly tied to the number of Medicare beneficiaries a teaching institution cares for, was capped by Congress as part of the Balanced Budget Act of 1997. Consequently, Medicare support for GME has been effectively frozen for a quarter century and as the population of the United States has grown, become more diverse, and geographically shifted, the Medicare GME has been unable to reflect these changes.
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