Diversification of GME Finances and Governance in a Non-Hospital Based, Not for Profit Consortium
Linda Thomas, Pavan Irukulla, Brian Ebersole, Wright Center for Graduate Medical Education
Lauren Meade, Baystate Medical Center
How the Problem was Identified/Explored:
The IOM Committee on Governance and Finance of GME is working on recommendations to better align
GME resource stewardship with the public’s health-care workforce needs. APDIM’s 2011 Program
Directors’ Survey highlights lacking financial information available to program leaders. The Wright
Center for Graduate Medical Education (WCGME) is a not for profit, diversified finance and governance
consortium model, which gives negotiating power for education and service priorities to inclusive GME
community stakeholders, rather than hospitals alone.
Description of the Innovation:
WCGME is an independent, not for profit sponsoring institution GME Consortia for a community based
Internal Medicine Residency with 3 federal funders: CMS, VA and HRSA, the latter as a pioneering
Teaching Health Center (THC) designee. This consortium employs core faculty and residents and directs
them across 3 community hospitals, a VA, 3 Federally Qualified Health Centers and 3 Wright Center for
Primary Care training sites. Non hospital/VA/THC training sites have Program Letters of Agreement
driving cost center allocation. The consortium has complete oversight for setting educational priorities
including current Milestones based curriculum/evaluation overhaul. Careful tracking of trainee rotations
allows financial cost center reconciliation reports to avoid “double dipping” and to track the true FTE
costs of Internal Medicine training.
Results:
Through a diversified GME consortium model, we deliver our community mission of service, education
and workforce training. CMS funds provide educational opportunities in core and subspecialty hospital
training (i.e. wards, ICU, CCU, subspecialties); VA funds enhance demographic exposure, especially in
Geriatrics; and HRSA funds promote a robust ambulatory THC curriculum inclusive of Medical Home,
EMR Meaningful Use, Public Health/Population Management, Care Coordination and Quality
Improvement competencies. Health care services provided have great value to institutional consortium
partners, while meeting accreditation requirements and duty hour compliance.
Reflection/Lessons Learned:
A shared accountability, not for profit consortium platform stewards GME resources transparently with
a win-win mindset promoting community relevance and benefit. GME funding and governance
diversification can fuel excellence, unify communities and empower GME program leaders to determine
service and educational priorities that optimize alignment with the highest national standards in patient
care delivery and resident education.