Reforming Graduate Medical Education

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Abstract
THE PHYSICIAN Payment Review Commission, created in 1986 to advise the US Congress on reform of Medicare's method of paying physicians, has developed a comprehensive policy designed to limit growth in residencies, shift the balance between subspecialists and generalists, and facilitate training in ambulatory settings.1 During the past 2 years, the commission has devoted considerable attention to physician supply, specialty distribution, and the financing of graduate medical education (GME). The national debate on health system reform offers the potential to structure more effective policies that will include all payers in new GME financing strategies and to develop different systems of service provision for uninsured people who historically have relied on teaching institutions as their source of care. The debate also provides an important opportunity, missing in the past, to coordinate policies regarding physician supply and training with those affecting payment for services, patients' access to care, and cost containment.

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