Our AMA adopts the following principles:

Graduate Medical Education Positions (1) The number of federally-funded entry-level graduate medical education positions should be reduced, over time, to no more than 120% of the number of 1997 graduates of U.S. MD- and DO-granting medical schools. The number of federally-funded entry-level positions should be monitored and there should be flexibility in the number and allocation of positions, so that regional and specialty needs can be met.

(2) Planning for the number of residency positions should take into account the contributions to patient care made by other health professions and occupations, considering that other health professions and occupations do not substitute for physicians.

(3) Guidelines for the number of funded positions should be developed by a private/public sector advisory body, which should exist outside of the regular governmental structure. The advisory body should have significant representation from the medical profession and the academic medical community.

(4) Explicit immunity from antitrust constraints should be provided to private professional groups, to allow participation in the national debate on the physician workforce.

(5) Program quality, based on an assessment of educational program outcomes under the leadership of the Accreditation Council for Graduate Medical Education and its Residency Review Committees, should be a factor in the allocation of funded residency positions.

(6) There should be no increase in the number of graduates from U.S. MD- and DO-granting medical schools over 1997 levels.

Funding of Graduate Medical Education (7) The direct costs of graduate medical education should be supported through a Graduate Medical Education Trust Fund that receives contributions from all payers for health care. The private/public sector advisory body should study and develop mechanisms for the distribution of funding from this Trust Fund.

(8) Financial support for residency training should be sufficiently stable to allow for meaningful planning. This requires a budgeting system that is not subject to an annual appropriations process. If a Graduate Medical Education Trust Fund is not established, funding for the direct costs of graduate medical education should remain within the Medicare program.

(9) Budgeting for the direct costs of graduate medical education should be based on a per-resident amount, which should move toward comparability across locations. The direct costs of GME include resident salaries, supervisory costs, and educational program overhead. Regional cost differences should be taken into account.

(10) Funding should follow residents to all educational sites. Any authorization, capitation, or "voucher" system should permit such distribution of funds to the sites that incur the costs of training.

Support for the Missions of Teaching Institutions (11) The indirect medical education adjustment (IMEA) through Medicare should be restored to a level that permits the maintenance of the education, research, and charity care missions of teaching institutions. This mechanism should be maintained until there are explicit alternatives to support the costs associated with higher acuity in teaching institutions and indirect costs associated with the presence of a teaching program.

(12) Transitional funds should be provided to teaching institutions that lose residents as a result of cuts in the number of funded positions. (CME Rep. 10, A-99; Reaffirmed: CME Rep. 2, A-00)