Developing a GME Policy Toolkit that States Can Use to Evaluate Return on Investment for Public Funds Invested in Training (2017-18)

Investigators: Erin Fraher, PhD, MPP; Tom Ricketts, PhD, MPH; Ryan Kandrack, BS


Background: Despite the release of numerous reports calling for national reform of Graduate Medical Education, little policy change has occurred at the federal level. However, numerous states are actively looking for innovative ways to redesign GME. As the demand for health care services increases, states are interested in understanding how to leverage their Medicaid funds to shape the size, specialty mix and geographic distribution of the workforce to meet population health needs.

While Medicare is the dominant source of funding for residency training in the United States, Medicaid provides $4.3 billion in GME support annually43. Medicaid dollars are attractive to states because they can be matched by federal dollars, increasing the total funding available to train the future physician workforce. Many states also invest state appropriations in GME training (for example, Nevada’s $10 million state appropriation for GME in 2016). Despite these large investments, states have little transparency or accountability for funds invested in GME in their state; they don’t know how many residents they train with these funds, which specialties they choose, or where these physicians practice after completing training. In a previous study of state-level GME reform, supported by HRSA through our HWRC, we found that states want to track workforce outcomes of residency training, but lack the data and analytical expertise to undertake these analyses.

Outcomes data would provide a way for state policymakers to hold residency programs accountable for producing physicians that meet the state’s workforce needs. For example, training programs with a “signature” of graduates who practice in primary care, psychiatry and general surgery in underserved communities might be targeted for increased funds while programs not producing the physician workforce needed in the state might have funds reduced.

Study aims: This study will develop and refine a methodology that states can use to evaluate the return on investment for public funds spent on Graduate Medical Education (GME). Armed with data about the outcomes of GME funds invested—in terms of yield of physicians in needed specialties and geographies–states can make more informed decisions about where to target future GME funds to produce the physician workforce needed to meet population health needs and ensure value for their investment.

The product of this project will produce a “toolkit” for measuring GME outcomes, from basic to advanced, that states can use to measure workforce outcomes for GME investments. The toolkit will describe the data sources that can be used and the variables needed from each data set for different workforce outcomes measures. Because states have varying levels of capability in terms of resources and expertise to analyze data on GME outcomes, we will develop different versions of the methodology, from basic to advanced, that states can use depending on their needs and capabilities.

Alignment with BHW priorities:

  • Methodology and evaluation of outcomes relevant to Division of Medicine and Dentistry, COGME, Teaching Health Centers programs, Children’s Hospitals GME
  • Will assist in development of performance measures PHSA §§749(d) 57(d); and 762(a)
  • Will result in improved data collection and analytic expertise in states


Related HWRC projects: 

Making Use of Workforce Projections to Inform the Graduate Medical Education Policy Debate in the United States (2014-15)

The Future of Medicaid-Funded Graduate Medical Education as the Health Care System Shifts (2015-16)

DocFlows: Mapping GME Location and Practice Location by Specialty (2016-17)

Exploring the Magnitude and Timing of Physician Specialty Changes (2016-17)

Investment in Graduate Medical Education Outcomes: An Analysis of Pediatric GME at the Residency Program Level (2017-18)

Association Between the Receipt of Title VII Funding for Medical Schools and Physician Workforce Outcomes (2017-18)


Project Products: 

Research Briefs
Presentations, webinars, and refereed conference papers and posters