Research for GME

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Impact of Increasing Obligated Service for Graduate Medical Education
December 1, 2003
This study estimates the impact of increasing the active duty obligation (ADO) for graduate medical education (GME). We found that the amount by which accession requirements could decrease depends on the size of the GME program. Specifically, accession requirements and costs are less if the GME program were optimized than if it were fixed at current levels. If GME is fixed, many accessions are needed, not to fill billets, but simply to support the GME program. We find that marginal increases—1-year increases—in the GME ADO are supportable. We based this finding largely on GME program directors’ perceptions and the willingness of current residents and fellows to consider and accept GME with a longer ADO. Because of the concurrent payback of the GME obligation with any prior obligation, there are many ways to structure a marginal increase in the ADO. How DoD should structure an increase depends on which specialties it wants to impact. We find that increasing the GME ADO more than marginally is not warranted because the applicant pool for accessions will not support it.
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Impact of Increasing Obligated Service for Physician Scholarships
October 1, 2003
This study estimates the impact of increasing the active duty obligation (ADO) for the Armed Forces Health Professions Scholarship Program (AFHPSP). We found that the amount by which accession requirements could decrease depends on the size of the graduate medical education (GME) program. Specifically, accession requirements and costs are less if the GME program were optimized than if it were fixed at current levels. If GME is fixed, many AFHPSP accessions are needed, not to fill billets, but simply to support the GME program. We find that increasing the ADO from 4 to 5 years for 4 years of subsidization is supportable. We based this finding on (1) recruiters’ perception that they could still meet the recruiting mission with a 5-year ADO, (2) the willingness of current AFHPSP students to consider and accept AFHPSP with a 5-year ADO, (3) the downward pressure on the medical billet file, and (4) the Services’ success in meeting recruiting goals that vary substantially from year to year. We find that increasing the AFHPSP ADO beyond 5 years is not warranted because it is not supportable from a recruiting standpoint and most AFHPSP students didn’t express a willingness to accept an obligation beyond 5 years.
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Life-Cycle Costs of Selected Uniformed Health Professions (Phase II: The Impact of Constraints and Policies on the Optimal-Mix-of-Accession Model)
April 1, 2003
We computed life-cycle costs for physicians, dentists, and other selected health care professions. Specifically, we computed the cost to access them, train them to be fully qualified duty special-ists, and maintain them in staff utilization tours. We computed the cost per year of practice (YOP) as a fully trained specialist with emphasis on the cost per YOP at the completion of the initial active duty obligation and at the expected YOP. We found that training costs are substan-tial—8 to 49 percent over compensation costs for physicians depending on specialty and acces-sion source. Given these life-cycle costs, we’ve developed a model to determine the optimal mix of acces-sions to fill future billet requirements. The optimum depends crucially on the model’s con-straints, which include the required experience profile, in-house training requirements, and ac-cession constraints. The results indicate that the required experience profile affects the optimum for physicians more than any other constraint, whereas in-house training requirements are the biggest driver in the dentist model. Looking at the impact of pay on the optimum, we found that accession bonuses are modestly cost-effective for some specialties and that targeted special pay increases are more cost-effective than across-the-board increases.
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