Volume 97, Number 3, March 2018 GME Funding and Curriculum in PM&R the overall total number of PM&R positions. Despite chair the importance of ongoing tracking of GME funding data and concern for loss and despite PM&R GME growth being less the alignment of funding with the resident experience, which than that of other fields, nationwide there was positive growth is best suited for patient care, employment of PM&R residents, in PM&R positions. Finally, chairs were instructed to consult and the needs of the growing population of Americans with with their local GME offices to determine the type and specific chronic disabling conditions. If there is discordance with funding, source for GME funding in their PM&R training program, but education, and patient needs, professional societies, such as the the reliability of the funding source data is not known. The Association of Academic Physiatrists, American Academy of confidence of the chair in determining whether funding is from Physical Medicine & Rehabilitation, the American Board of the hospital, department, and CMS, or other source was not PM&R, and all practicing physiatrists must advocate for cur- assessed nor was the actual funding source verified. ricular and GME funding reform. Based on our data, advocacy Despite these limitations, data provided here describe cur- for the inclusion of a greater variety of postacute care educa- rent resident experiences in postacute care settings, chair opin- tional experiences needs to be pursued. ion on the need for these experiences, and the type of practice that graduates enter. These appear to be detached from ACGME REFERENCES requirements for postacute patient care, which are lacking, and from CMS funding, which remains highly correlated to inpatient 1. Institute of Medicine: Graduate Medical Education That Meets the Nation's Health Needs. Washington, DC: The National Academies Press, 2014. Available at: https://www.nap.edu/ beds. If the recommendations of the 2014 Institute of Medi- read/18754/chapter/1#ii. Accessed March 9, 2017 cine report are fulfilled, GME payment adjustments that are 2. Accreditation Council for Graduate Medical Education (ACGME) Data Resource Book: based instead on whether a teaching hospital trains residents Available at: http://www.acgme.org/About-Us/Publications-and-Resources/Graduate- Medical-Education-Data-Resource-Book. Accessed March 9, 2017 in a variety of clinical settings/systems and in multispecialty 1 3. Association of American Medical Colleges. Medicare Resident Limits (“Caps”): Available at: and interprofessional teams may greatly benefit PM&R. https://www.aamc.org/advocacy/gme/71178/gme_gme0012.html. Accessed March 9, 2017 This study also highlights that further exploration of work- 4. United States Census Bureau, Census Bureau Reports. Nearly 1 in 5 People Have a Disability in the U.S.: Available at: https://www.census.gov/newsroom/releases/archives/miscellaneous/ force needs in PM&R is essential. The degree of chair percep- cb12-134.html. Accessed March 9, 2017 tion of instability in current PM&R GME positions is surprising 5. Jolly P, Erikson C, Garrison G: U.S. graduate medical education and physician specialty as is the number of respondents who felt their GME program to choice. Acad Med 2013;88:468–74 be undersized; these clash to some degree with actual, but not 6. Riaz M, Palermo T, Yen M, et al: The projected responses of residency-sponsoring institutions to a reduction in Medicare support for graduate medical education: a national survey. relative, PM&R GME growth and with recent workforce- Acad Med 2015;90:1380–5 needs assessments that predict a surplus of PM&R physi- 7. Health Workforce Projections: Physical Medicine and Rehabilitation Physicians and 7,8 cians. In a 2016 review of the unpredictability of physician Physician Assistants. March 2017. Available at: https://bhw.hrsa.gov/sites/default/files/bhw/ health-workforce-analysis/research/projections/BHW_FS_Phy_Med_Rehab.pdf. workforce projections, three conclusions are noteworthy to re- Accessed June 15, 2017 view relevant to this discussion: (1) policy makers need to de- 8. ArmstrongDP, LiuY,Forte GJ: 2015 New York Residency Training Outcomes: A Summary vote more attention to workforce projections, (2) more research of Responses to the 2015 New York Resident Exit Survey. Rensselaer, NY, Center for Health devoted specifically to the workforce implications of delivery Workforce Studies, School of Public Health, SUNY Albany, 2016 9. Shanafelt TD, Hasan O, Dyrbye LN, et al: Changes in burnout and satisfaction with work-life and payment reforms is strongly needed, and (3) these should balance in physicians and the general US working population between 2011 and 2014. be pursued with a sense of urgency. Mayo Clin Proc 2015;90:1600–13 The amalgamation of all of these factors (residents' actual 10. Accreditation Council for Graduate Medical Education (ACGME) Program Requirements for Physical Medicine & Rehabilitation: Available at: https://www.acgme.org/Specialties/ experiences and leadership perception of the need for such ex- Program-Requirements-and-FAQs-and-Applications/pfcatid/17/Physical%20Medicine% periences, graduates' experiences, patient care volume and needs, 20and%20Rehabilitation. Accessed March 9, 2017 and workforce needs) should help drive reform in PM&R 11. Grover A, Orlowski JM, Erikson CE: The nation's physician workforce and future challenges. GME curriculum. Moving forward, this study underscores Am J Med Sci 2016;351:11–9 1 2,3 In reaffirming our previous Expression of Concern, two articles by Sato et al have been retracted due to concerns regarding research misconduct, data integrity, and inappropriate assignment of authorship. This retraction is consistent with the results of an investigation conducted by Dr. Sato’s University at the time. REFERENCES 1. Expression of concern. Am J Phys Med Rehabil 2017;96:761 2. Sato Y, Kuno H, Kaji M, et al: Effect of ipriflavone on bone in elderly hemiplegic stroke patients with hypovitaminosis D. Am J Phys Med Rehabil 1999;78:457–63 3. Sato Y, Kanoko T, Yasuda H, et al: Beneficial effect of etidronate therapy in immobilized hip fracture patients. Am J Phys Med Rehabil 2004;83:298–303 DOI: 10.1097/PHM.0000000000000893 © 2017 Wolters Kluwer Health, Inc. All rights reserved. www.ajpmr.com 221 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
American Journal of Physical Medicine & Rehabilitation – Wolters Kluwer Health
Published: Jan 1, 2018
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