Report from the Council of Emergency Medicine Residency Directors subcommittee on graduate medical education funding: Effects of decreased Medicare support

Introduction: Recent changes by the Health Care Financing Administration (H CFA) have resulted in decreased Medicare support for emergency medicine (EM ) residencies. Objective: To determine the effects of reduced graduate medi cal education (GME) funding support on residency size, resident rotations, and support for a fourth postgraduate year (PGY) of training and for reside nts with previous training. Methods: A 36-question survey was developed by the Council of Emergency Medicine Residency Directors (CORD) committee on G ME funding and sent to all 122 EM program directors (PDs). Responses were c ollected by the Society for Academic Emergency Medicine (SAEM) office and b linded with respect to the institution. Results: Of 122 programs, 109 (89%) responded, of which 78 were PGY 1-3 programs, 19 were PGY 2-4, and 12 were PGY 1-4. The PDs were asked specifically whether there were changes in pro gram size due to changes in Medicare reimbursement. Although few programs ( 12%) decreased their size or planned to decrease their size, 39% had discus sions regarding decreasing their size. Thirty percent of the PDs responded that other programs at their institution had already decreased their size; 26% of the PDs had problems with financing outside rotations; and 24% had a decrease in off-service residents in their emergency departments (EDs). On ly seven (6%) of programs paid residents from practice plan dollars, while most (82%) were fully supported by federal GME funding. Nearly all four-yea r programs (97%) received full resident salary support from their instituti ons and 77% of programs accept residents with previous training. Conclusion s: Nearly all EM programs are fully supported by their institutions, includ ing the fourth postgraduate year. Most programs take residents with previou s training. Although few programs have reduced their size, many are discuss ing this. Many programs have had difficulty with funding off-service rotati ons and many have had decreased numbers of off-service residents in their E Ds. Recent GME funding changes have had adverse effects on EM residency pro grams.