Federal authorization ends for COGME in September

The Council on Graduate Medical Education, a congressional advisory group appointed to examine physician work force trends and policies impacting graduate medical education, soon might cease to exist.

As of Sept. 30, congressional authorization for the council will end, and Carl Getto, MD, chair of COGME and senior vice president of medical staff affairs at the University of Wisconsin Hospital & Clinics in Madison, said there is no legislation pending to renew COGME's mandate.

Dr. Getto said if COGME is disbanded, the public will lose an important forum for discussing proposed government policy and its impact on graduate medical education. He said COGME's demise also would leave the country without an independent, unbiased body dedicated to examining physician supply.

"If we are going to maintain a reasonable supply of physicians and other health professionals, we need to be looking at this issue more often than every 10 years," Dr. Getto said. "If we don't have a group charged with doing it, the chance it will be done is small."

Congress first authorized COGME in 1986. It is most known for predicting that the United States would have a surplus of physicians by 2000 that would manifest itself in a surplus of specialists and a shortage of primary care doctors. COGME recommended that the government limit the number of medical residents and keep half of the total number of residency slots in primary care. The recommendations were adopted by Congress.

But COGME reversed its position in the fall of 2003, predicting a shortage of 85,000 doctors by 2020, with the demand for specialists being particularly strong.

Richard Cooper, MD, director of the Medical College of Wisconsin's Health Policy Institute in Milwaukee and a critic of COGME, said others would fill any gap left by COGME's disbanding.

"They got it wrong and helped to create the crisis that we're in," said Dr. Cooper, who predicted an impending doctor shortage before COGME. "On the other hand, there needs to be some objective body that assists the government in evaluating graduate medical education."

Dr. Cooper said that the Medicare Payment Advisory Commission, an independent federal body that advises Congress on issues affecting the Medicare program -- including Medicare expenditures for graduate medical education, physician and resident supply and specialty mix -- could step in and fill the gap.