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 (HCFA) have resulted in decreased Medicare support for emer- gency medicine (EM) residencies. Objective: To de- termine the effects of reduced graduate medical ed- ucation (GME) funding support on residency size, resident rotations, and support for a fourth postgrad- uate year (PGY) of training and for residents with previous training. Methods: A 36-question survey was developed by the Council of Emergency Medicine Residency Directors (CORD) committee on GME funding and sent to all 122 EM program directors (PDs). Responses were collected by the Society for Ac- ademic Emergency Medicine (SAEM) office and blinded 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 program size due to changes in Medicare reimbursement. Although few programs (12%) decreased their size or planned to decrease their size, 39% had discussions regarding decreasing their size. Thirty percent of the PDs responded that other programs at their institution had already de- creased their size; 26% of the PDs had problems with financing outside rotations; and 24% had a decrease in off-service residents in their emergency depart- ments (EDs). Only seven (6%) of programs paid resi- dents from practice plan dollars, while most (82%) were fully supported by federal GME funding. Nearly all four-year programs (97%) received full resident salary support from their institutions and 77% of pro- grams accept residents with previous training. Con- clusions: Nearly all EM programs are fully supported by their institutions, including the fourth postgrad- uate year. Most programs take residents with previ- ous training. Although few programs have reduced their size, many are discussing this. Many programs have had difficulty with funding off-service rotations and many have had decreased numbers of off-service residents in their EDs. Recent GME funding changes have had adverse effects on EM residency programs.