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PRINCIPLES REGARDING GRADUATE MEDICAL EDUCATION

 AND SPECIALTY DISTRIBUTION

The American Medical Student Association:

1.             URGES the development of a universal qualifying exam for all medical school graduates for admission into U.S. graduate medical programs; this examination should:

a.             contain mechanisms to directly measure the ability of physicians to care for patients; and

b.             provide a criterion-reference rather than a norm-reference standard in evaluation of examinees.

2.             URGES the inclusion of the following information in the AMA Directory of Approved Residencies and in the American Osteopathic Association (AOA) Opportunities Directory:

a.             remuneration (stipend, cash living out allowance, cash for attending educational conferences);

b.             night call schedule;

c.             minimum number of positions available for each year of any sequential residency program.

3.             ENCOURAGES the use and expansion of flexibly-scheduled or part-time internships and residencies in all fields of medicine and further ENCOURAGES such programs to be fully described and included in the AMA Directory of Approved Residencies and in the AOA Opportunities Directory and in the computer match program of the National Resident Matching Program (NRMP);

4.             RECOGNIZES the NRMP as a valuable service but SUPPORTS improvements to the NRMP or alternative models that would provide more choice and increased negotiating abilities for applicants;  (2000)

5.             URGES all participants in the NRMP to adhere to the spirit, as well as the letter, of the NRMP, and SUPPORTS the attempts of groups, such as the Organization of Student Representatives, to monitor and report NRMP violations;

6.             URGES the NRMP to investigate alternatives that will expedite the selection process and will allow adjustments for working spouses and those students who graduate earlier than the traditional May or June dates;

7.             SUPPORTS the student-optimal algorithm as implemented in 1997 along guidelines proposed by AMSA; (2005)

8.             SUPPORTS the input of medical students in all decisions regarding the Match by including a seat for medical students, with full voting privileges, on the NRMP Board; (1996)

9.             SUPPORTS the concept of increased postgraduate programs in primary care on a national scale, though not to a uniform extent, recognizing unique goals, priorities and resources of individual institutions, and, further, SUPPORTS the regulation of the number of residency programs to affect a more significant redistribution of specialties, again recognizing the unique specialty institutions;

10.           SUPPORTS more active involvement by State Licensing Boards in determining physician needs by specialty and geography within each state, such information to be distributed to physicians desiring licensure in that state;

11.           URGES that medical students be allowed to take Part 3 of the National Boards and further URGES each Specialty Board to reevaluate current programs leading to certification with the goal of reducing the time required by the formal education program (i.e., allowing credit for electives taken in the specialty during medical school and/or internship);

12.           OPPOSES delayed licensure of house staff;

13.           BELIEVES that the resident duty hour regulations as adopted by the ACGME in July 2003 are currently insufficient to ensure maximized patient and resident safety and health, and URGES the ACGME to implement more thorough and comprehensive regulations as described in detail in the Principles Regarding Resident and Student Work Hours. (2005)

14.           SUPPORTS efforts of house staff officers throughout the country to secure improved working conditions and improved standards of patient care;

15.           SUPPORTS moonlighting as a beneficial and legitimate practice but does not regard it as an adequate solution to either inadequate house staff salaries or the maldistribution of health care;

16.           SUPPORTS the recognition of interns, residents and clinical fellows as “employees” within the context of the National Labor Relations Act; and, that house staff organizations be recognized for collective bargaining;

17.           SUPPORTS the concept of recertification of physicians by specialty boards requiring additional study in the respective area and periodic recertification exams;

18.           URGES all institutions providing graduate medical education to establish standard maternity and paternity leave policies for house officers, which allow variation with the personal and medical needs of the individual but assure the individual a reasonable minimum time away from ward and clinic responsibilities if desired; and URGES the inclusion of these policies in all recruitment materials and contracts;

19.           Regarding Emergency Medicine:

a.             URGES creation and maintenance of emergency medicine departments at each medical school equivalent in status and with adequate financial support as to ensure quality similar to other major clinical departments of that school;

b.             SUPPORTS the continued improvement and development of quality Emergency Medicine residency programs.

20.           SUPPORTS continued funding of house staff salaries in teaching hospitals through patient care revenues, and BELIEVES that Medicare should pay its proportionate share of these services; (1985)

21.           SUPPORTS efforts on the part of the federal government to influence the specialty distribution of physicians through allocation of funds to residency programs based on the projects need of certain medical specialties; (1985)

22.           OPPOSES cuts in the funding of graduate medical education until studies presently underway are able to identify what accounts for the higher costs associated with being a teaching facility, and what effects these cuts would have on patient care and medical education. (1985)

23.           STRONGLY URGES the Accreditation Council for Graduate Medical Education (ACGME) to amend the General Essentials of Accredited Residencies, Eligibility and Selection of Residents to read, “There must be no discrimination on the basis of sex, age, race, creed, national origin or sexual orientation and gender identity.” (1989)

24.           STRONGLY URGES the AOA to incorporate in its Intern Training Program Policies and Procedures and its Residency Training Requirements a nondiscrimination policy to read “There must be no discrimination on the basis of race, color, sex, religion, creed, national origin, age, handicap or sexual orientation and gender identity.” (1989)

25.           BELIEVES that all educational and professional opportunities should be equal for both allopathic and osteopathic students and professionals, including but not limited to, preceptorships. To this end, a single national match should be developed which would incorporate all ACGME and AOA approved graduate training programs. Such a match would eliminate the problem of osteopathic medical students reneging on AOA commitments to seek ACGME training; but would also allow osteopathic medical students to apply to BOTH AOA and ACGME approved programs, which the current AOA proposal (approved by the NRMP) would not. (1992) (2000)

26.           ENDORSES the Third Report of the Council on Graduate Medical Education (Improving Access to Health Care Through Physician Work Force Reform:  Directions for the 21st Century) and its recommendations, believing that on a nationwide level, the needs of society (as defined by AMSA’s policies) should be a factor in determining the overall distribution of physicians by specialty and by practice location. (1993)

27.           SUPPORTS  the creation of residency programs in underserved communities. (1994)

28.           SUPPORTS requiring primary care residencies to offer rotations in underserved communities. (1994)

29.           SUPPORTS increased federal funding for primary care residencies. (1994)

30.           BELIEVES that abortion care should be a required component of Ob/Gyn residency training, with exemption on the basis of personal principles, and BELIEVES that Ob/Gyn and family medicine residents should have adequate opportunity to obtain experience in abortion care with a sufficient number of cases to obtain proficiency. (1994)

31.           SUPPORTS the creation of a public all-payer pool for funding graduate medical education.  This public all-payer fund should be tied to all public and private insurance premiums and should be designed to achieve policy goals serving the public's health. (1997)

32.           SUPPORTS changing immigration law to tighten the visa process for foreign medical graduates ensuring that they return to their native countries for service upon completion of training. (1997)

33.           SUPPORTS relocating the training of physicians at the undergraduate and graduate levels into accredited community, ambulatory and managed care based settings for a minimum of 25 percent of clinical experience. (1997)

34.           ENCOURAGES the surgical, medical, and pediatric subspecialty groups and the ACGME to create and accredit, for each subspecialty, single-track residencies which will begin directly upon completion of medical school. (1997)

35.           RECOGNIZES the value of the AOA osteopathic rotating internship and ENCOURAGES osteopathic graduates to enter such internships, but OPPOSES the requirement of completion of such an internship as a prerequisite to state licensure for D.O.s. (1998)

36.           ENDORSES the 2005 COGME Report (COGME’s 16^th Report to Congress) and RECOGNIZES that there is a growing physician shortage in the United States that will reach the level of at least 90,000 full-time physicians by 2020 unless action is taken to address the shortage immediately; (2006)

37.           ENCOURAGES medical schools to expand capacity and increase building of new medical schools to fill shortage of physicians; (2006)

38.           ENCOURAGES continued federal and independent study on how to project trends in the physician workforce, especially in regards to specialty choice among medical school graduates. (2006)

39.           URGES legislation that expands Medicare funds to support the expansion of undergraduate medical education in the United States . (2006)

40.           SUPPORTS increase supply and distribution of physician/PA teams to meet anticipated shortage of healthcare service. (2006)