GME Development and Expansion

Studies of the physician provider market have determined that the U.S. is facing a crisis – a significant shortage of physicians, which is most pronounced in primary care. Although more medical schools have opened, residency positions have not increased proportionally to support graduating medical students. As a result, many healthcare organizations have begun to embrace expanding GME as a key strategy to meet organizational and community primary care needs.

ACA collaborates with our clients’ leadership, clinical faculty, community leaders, and other healthcare providers (e.g., FQHCs and RHCs) to develop a strategy that aligns with the hospital’s mission and is financially sustainable.

If the decision is made to move forward with a new program, ACA will assist in the ACGME application process by supporting application development, providing recommendations, and unlimited reviews of all required attachments and documents before submission.

Although the primary focus of ACA's work is on ACGME programs, our consultants possess extensive expertise in initiating Podiatry and Dental residency programs. These additions can enhance the breadth of medical education available within your community.

Evaluation Criteria Include:

Assessment of community and organizational physician workforce needs
Evaluation of current clinical services and capacity to sustain growth, particularly in the targeted training areas
GME reimbursement profile and cash flow implications
Facility space analysis to determine redesign or expansion requirements
Evaluation of partnership opportunities

Naïve Hospitals

GME naïve hospitals are often community hospitals, with fewer beds and limited clinical volumes than larger university affiliated medical centers. They may be located in rural areas with limited financial resources and a limited number of physicians available for teaching. However, with proper structuring, community hospitals can be suitable candidates for GME. To determine viability and create a sustainable strategy, ACA’s proven approach evaluates critical factors, including clinical volume, faculty availability, financial support, and reimbursement profiles. We collaborate with our clients to assess potential GME partners. These partnerships are designed to offer additional resident rotation opportunities, continuity clinic sites, supplemental faculty, and expense sharing. Commonly considered partners include Critical Access Hospitals and Federally Qualified Health Centers (FQHCs).

Academic Teaching Hospitals

Academic teaching hospitals that are exploring program expansion may encounter Medicare cap limitations and other reimbursement constraints. Expansion opportunities can be funded using strategies such as redesignating as a rural hospital to address the cap shortfalls and initiate new programs, or by starting rural training programs. These approaches can be effective if these financial strategies align with the institution’s strategic goals and leadership's vision. As a result of increasing GME costs, additional funding sources have become a prominent part of the funding equation. Those include state funds, HRSA, and select grants specific to GME. Additionally, fellowships could be started to expand the GME footprint and meet the organization's strategic objectives.

Critical Access Hospitals Federally Qualified
Health Centers

Critical Access Hospitals (CAHs) and Federally Qualified Health Centers (FQHCs) rely heavily on the primary care providers to meet the clinical needs of their community. Efforts to establish GME programs within these healthcare organizations are increasing, driven by the essential services they offer to the communities they serve, particularly in rural areas. CAHs and FQHCs are both eligible to sponsor ACGME-accredited programs. Partnering with tertiary hospitals helps address issues such as limited clinic volume and faculty shortages, which are necessary to maintain academic standards. FQHCs provide a suitable patient panel for meeting continuity clinic requirements and serve as an efficient ambulatory training platform, especially for Family Medicine residency programs. ACA's structured approach is to develop a strategy that aligns the community service providers to enhance the clinical delivery capability to the community while encouraging residents who train in these systems to become their future providers.