Putting the Roadmap to a Comprehensive State Graduate Medical Education Strategy into Practice: State Perspectives

Abstract

Physician workforce shortages are limiting access to health care in nearly every state, with underserved and rural areas facing the greatest shortfalls. The case examples herein highlight how three states — Missouri, North Carolina, and Wisconsin — are planning and implementing aspects of their tailored state graduate medical education strategies, as outlined in A Roadmap for Building and Implementing a Comprehensive State Graduate Medical Education Strategy: Actionable Steps to Align Investments with Workforce Needs. Each state strategy has its own objectives, such as filling the medical school-residency training gap or sustaining a rural workforce, yet offers insights for other states planning a “grow your own” approach to expanded residency training.

Introduction

Physician workforce shortages are limiting access to health care in nearly every state, with underserved and rural areas facing the greatest shortfalls. To become board certified and licensed to practice, a physician must complete residency training after medical school. Research demonstrates physicians are likely to practice near where they train, and this evidence has encouraged states to adopt a “grow your own” strategy to expand residency training, also known as graduate medical education (GME), with the intention of retaining physicians in-state after residency.

Graduate medical education (GME) is the required training physicians complete after medical school to practice in a specialty. GME includes residency and fellowship training that varies in length by specialty. GME is paid employment in a structured, closely supervised clinical training environment.

Addressing physician workforce shortages requires a coordinated statewide approach. States play a key role in shaping GME not only as funders but as workforce planners and conveners. A Roadmap for Building and Implementing a Comprehensive State Graduate Medical Education Strategy: Actionable Steps to Align Investments with Workforce Needs provides states with an evidence-based framework that organizes a GME growth strategy into five iterative stages.

Examining existing state approaches to expanding and sustaining GME capacity offers valuable insights into how states can design and finance GME to meet population health needs and how state investments can complement federal efforts to expand the workforce and enhance care in underserved communities. Federal investments total more than $28 billion annually and are primarily funded through Medicare, with substantial contributions from Medicaid, the US Department of Veterans Affairs, the US Department of Defense, and the Health Resources and Services Administration.

This report summarizes state case examples, presenting state trends in physician supply, the number of physicians practicing in key specialties, and the distribution of physician training sites in the state. (These data are sourced from the Carolina Health Workforce Research Center, the North Carolina Graduate Medical Education Technical Assistance Center, the Missouri Department of Health and Senior Services, and the Wisconsin Collaborative for Rural Graduate Medical Education.)

Each case also includes a summary of current progress on the state’s development, implementation, and evaluation of a tailored state GME strategy, informed by state framework developers and administrators. These state case studies, along with Table 1 from A Roadmap for Building and Implementing a Comprehensive State Graduate Medical Education Strategy, illustrate models states have used to grow GME capacity, strengthen the health workforce, increase access to care, and address critical population health priorities.