GME Support and Expansion - Strategies to Support Primary Care

Two recent Health Affairs blog posts cite strategies to re-engineer Graduate Medical Education (GME) to better serve integrated primary care.

• Expansion of the Teaching Health Center Graduate Medical Education (THCGME) program could help to address the current primary care physician shortage as well as the mental health workforce shortage, according to the authors of two Health Affairs Blog posts. The first post “Teaching Health Centers: Targeted Expansion for Immediate GME Reform” proposes modifications to the recently developed THCGME program to meet the growing primary care needs of the United States population. The lead author of the blog post is Dr. Richard Rieselbach, Professor Emeritus at the University of Wisconsin School of Medicine and Public Health. Eight additional co-authors contributed to the post as well. They explain, there are currently “sixty THCGME programs in 24 states […] training over 550 residents.” Evidence indicates that “over 90 percent of graduates” from the THCGME programs intend to work in primary care, with a higher than average rate indicating intention to work in underserved communities. The authors call for legislation to establish sustainable support for the THCGME program as well as support for program modification and enhancement, given the critical need for primary care providers. The proposed THCGME enhancements include increasing the number of funded residency positions, emphasizing training in rural and urban underserved areas, and modifying graduate medical education (GME) curriculum to integrate training in behavioral medicine. Implementing the proposed modifications could increase the number of well-trained providers entering the primary care workforce, alleviating a portion of the primary care provider shortage. However, these changes cannot be achieved without enacting legislation to provide sustainable and increased support for the THCGME program.

“This relatively simple, widely supported initiative can accelerate GME training to deliver a new generation of physicians prepared to provide the right care and services to patients when and where they are needed.”

• The second post, “Integrating Behavioral Medicine into Primary Care GME: A Necessary Paradigm for 21st Century Ambulatory Practice,” describes the advantages of incorporating behavioral medicine training into the THCGME program for pediatricians, general internists, and family medicine physicians in light of the current mental health workforce shortage. The lead author is Dr. Alan Axelson, the Medical Director of InterCare Psychiatric Services in Pittsburg. The seven authors argue that THCGME curriculum should include training in medication management as well as brief evidence-based psychotherapy or counselling for treating common mental health (MH) issues encountered in primary care (PC) settings. Treating MH issues in PC may be beneficial for many reasons such as reducing stigma for patients and patients may be more likely to seek help from a provider with whom they have an established relationship. Additionally, if PC providers are trained to provide treatment for common MH disorders, this may allow “mental health clinicians to focus on the most challenging patients.” The THCGME curriculum may also be expanded based on the specific PC discipline to include training in geriatrics, preventive medicine, palliative medicine, and public health. Integrating behavioral medicine as well as other areas of training into the existing THCGME curriculum may help prepare “effective and knowledgeable leaders” for the primary care workforce.

Learn more about the GME recommendations by the Institute of Medicine.