California’s diverse population — the biggest in the United States — is growing. The state has an urgent need to train a modern health care workforce with the skills required to provide care in a rapidly evolving environment. Physicians develop those skills from graduate medical education (GME), which is a period of residency and fellowship training undertaken after graduation from a school of allopathic or osteopathic medicine. GME is a vital pipeline.

Recommendations for Expanding GME

To ensure California has an adequate physician workforce to meet the needs of the state’s population, California must enact policy to expand GME, especially in underserved regions of the state and for underserved populations. Training Tomorrow’s Physicians: Recommendations for Expanding Graduate Medical Education Funding in California (PDF) presents recommendations for organizing and funding the expansion of GME in California.

Key takeaways include:

• There are insufficient GME positions in California to meet the demand for physicians, especially in shortage specialties and regions.
• Millions of federal dollars are available to assist with GME expansion in California: in particular, Medicare GME funds for Medicare GME–naive hospitals, Medicaid matching funds for Medi-Cal managed care, and Department of Veterans Affairs (VA) funds for GME programs partnering with VA training sites.
• California has recently taken critical steps to invest more state dollars in GME expansion through the Song-Brown and Proposition 56 GME programs, but needs to protect that investment through the state budget process.
• A California governance structure is required to coordinate the complex and deeply fragmented system of GME subsidies, to guide GME expansion, and to improve transparency and accountability.
• California can learn from other states that have been successful in GME expansion.

Overview of GME Funding

A Guide to Graduate Medical Education Funding in California (PDF) explores the funding behind GME in California. It seeks to describe the institutions and bodies that provide funding, and how they allocate funds, where they do their work, and which types of residencies they approve. Overall, it offers a view into a complex and deeply fragmented system of subsidies that could have a tremendous impact on the future of California’s health care workforce.

Issue Briefs

As part of this series, the following issue briefs offer a closer look at some of the key issues facing GME funding in California:

• Psychiatrist Shortage (PDF)
• Primary Care Physician Crisis (PDF)
• Medical Residents: Where Are They From? (PDF)
• Geographic Distribution of Residencies (PDF)
• Who’s Training Whom? (PDF)
• Medicare GME Funding 101 (PDF)
• The Song-Brown Program (PDF)

The slideshow below highlights six key points about GME funding in California.

These papers were authored by Diane Rittenhouse, MD, Alexandra Ament, and Kevin Grumbach, MD, of the University of California, San Francisco, and Stephen Petterson, PhD, Zachary Levin, and Andrew Bazemore, MD, MPH, of the Robert Graham Center.