Threats to graduate medical education funding and the need for a rational approach: a statement from the alliance for academic internal medicine.

With the current focus on reducing the federal budget deficit, funding for graduate medical education (GME) has come under scrutiny, particularly those monies labeled as indirect medical education payments; these are intended to cover ill-defined costs inherent to training programs, such as increased lengths of stay, additional testing, and patients with more complex conditions. Although there are cogent arguments that indirect medical education expenses have decreased over the past 25 years, there is also a reasonable expectation that direct medical education expenses, such as those related to resident salaries, faculty involvement, administration of programs, and overhead costs, have increased. Our current system of GME financing is complex and cumbersome and relies almost exclusively on government support. This article examines the adequacy of current funding, focusing on the economics of the entire system rather than individual hospitals, states, or regions. It also recommends reexamining GME financing and considering options that ensure appropriate levels of government support and participation of other health care insurers to adequately fund GME.