Date of Award

January 2016

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Howard P. Forman

Abstract

Resident education is an indispensable component of physician training, yet the funding for Graduate Medical Education (GME) has become an increasingly controversial topic in the United States. GME funding is a predominantly federal subsidy awarded to academic hospitals in compensation for the cost of resident training. The poor financial transparency of GME-funded hospitals and the lack of objective outcome metrics have called into question the utility of this funding. However, eliminating federal funding for the costly resident training programs jeopardizes the future of academic medicine. Here, we investigated impact of GME funding on three tenants of hospital operations and performance: hospital financial standing, patient outcomes evaluation and resident academic performance. We created the first publically-available ranking model specific to healthcare intuitions, the Yale Model, and validated it using a series of statistical methods and through comparison with existing proprietary models. Using the Yale Model, we showed that GME funding is negatively correlated with hospital financial standing, contradicting the criticism that hospitals become wealthy because of this subsidy. We found no impact of GME funding on patient outcomes, but showed a significant effect on resident performance on board exams. These mixed results call for increased transparency in the way that GME funds are used by hospitals and the implementation of outcomes-based allocation as a stimulus for accountable use. We believe that GME is a non-dispensable subsidy, but its use and distribution should be congruent with the aforementioned reforms.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 08/24/2017

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