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American Academy of Family Physicians (AAFP) Joins Cap Flex Coalition

The AAFP encourages CMS to provide flexibility in the time allowed for new teaching hospitals to establish their cap for primary care residents in those areas considered to be underserved, rural and/or under-resourced.




The American Academy of Family Physicians (AAFP), which represents 131,400 family physicians and medical students across the country, urges the Centers for Medicare & Medicaid Services (CMS) to provide for more flexibility in Graduate Medical Education (GME) cap-setting to help offset the growing shortage of family physicians in areas of need throughout the country.


Most physicians practice in the same state in which they complete their training, and so establishing or expanding residency programs is an effective means of increasing the local physician population. However, these programs are not viable without Medicare GME funding. Sponsoring institutions for residency programs are limited by the cap on Medicare support for GME imposed by the Balanced Budget Act of 1997. Currently, a new teaching hospital (institution) has five years to establish its Medicare GME funding cap on the number of residency positions, thereby establishing a permanent ceiling for Medicare GME funding. The cap is set at the number of residents at the institution five years after the first resident begins to work there. Despite efforts of existing and new U.S. medical schools to increase enrollment, corresponding residency training positions at teaching hospitals have not grown as significantly.


In addition, the demand for physician services continues to grow in many areas of the country, yet there is little or no growth in supply in those areas where the need is greatest. The AAFP, therefore, encourages CMS to provide flexibility in the time allowed for new teaching hospitals to establish their cap for primary care residents in those areas considered to be underserved, rural and/or under-resourced. Doing so would help address urgent primary care workforce shortages and the unequal geographic distribution of current GME programs. The AAFP believes five years is an insufficient window for most new programs to recruit medical educators, build infrastructure, receive accreditation, and maximize enrolled residents. Additional time is critically important in areas where the development of new primary care residency programs is underfunded. The current 5-year window is not sufficient to scale these programs to their full potential. The AAFP believes new teaching hospitals in economically-depressed or underserved areas with an expressed intention to establish family medicine residency programs should be exempted from the 5-year deadline and provided with the flexibility needed to fully establish their programs.


Furthermore, the AAFP encourage CMS to explore opportunities with the CMS Innovation Center to address primary care physician workforce shortages in underserved, rural, and/or under-resourced communities. As the agency explores further GME policy, the AAFP urge CMS to consult the AAFP’s Graduate Medical Education financing policy. In detail it discusses six principles to improve the production of primary care physicians.

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