The United States contributes almost $10 billion a year from Medicare into funding the Graduate medical education (GME) system but it fails to provide the workforce needed for the 21st century and lacks the necessary transparency and accountability.

Instead, it is more like political cronyism. New York, for example, gets 20% of the total while 29 other states, including places with a severe shortage of physicians with far more seniors and poor patients, get less than 1 percent.

It's not a new issue. Since it started more than 30 years ago, funding under the graduate medical education (GME) system has been problematic, but with an aging population and millions of people newly registered for health insurance because of the Affordable Care Act, there is a pressing need to increase the number of primary care physicians.

Yet in the United States, it is estimated that only 20.9 percent of residents graduating from GME programs will actually practice primary care.

What to do? Recommendations recently published in the Journal of General Internal Medicine prepared by the Health Policy Education Subcommittee of the Society of General Internal Medicine (SGIM), recommend the following based on workforce analysis, funding mechanisms, transparency, competency-based curriculum accountability, distributions of physician specialties and educational innovation:

• Fully funding the National Health Care Workforce Commission
• Having all payers for care contribute toward GME
• Rebasing direct and indirect medical education payments to reflect 21st century costs
• Requiring transparency in spending GME funds
• Using GME funding exclusively for trainee education and related costs
• Requiring training programs demonstrate their graduates are competent to practice 21st century medicine
• Developing incentives for training programs to align the practice patterns of their graduates with regional and national workforce needs
• Funding to develop GME innovations designed to impact the physician workforce positively.

"SGIM hopes its policy and paper will invigorate the debate on GME funding, moving beyond discussions limited to funding levels to discussions on GME program accountability for public fund use and how to shape a GME system that will provide the nation with the physician workforce that we need," write  the authors.