2015 ACS Governors Survey:
Surgeons speak out
on GME funding issues
Mark W. Puls, MD, FACS
Editor’s note: The American College
of Surgeons (ACS) Board of Governors
has conducted an annual survey of its
members for more than 20 years. The
purpose of the survey is to provide a
means of communicating the Governors’ concerns to the ACS leadership.
The 2015 ACS Governors Survey, which
was conducted in August 2015, had a
76. 2 percent (208/273) response rate.
The following article focuses on funding
for graduate medical education (GME)
and is the last in a series of three feature articles highlighting key issues
addressed in the Governors Survey.
The previous articles were published
in the April and May issues of the
Bulletin and centered on the electronic
health record and the Affordable Care
The 2015 Governors Survey provided data on the Governors’ age range, surgical practice setting, and the type or size of the hospitals where they work. Through a deeper analysis,
answers to survey questions were linked to these different demographic categories. Most ACS Governors are 51–65 years old (see
Figure 1, page 28), and most ( 52 percent) are in full-time academic
practice (see Figure 2, page 28). Of the remaining survey respondents, 28 percent are in private practice; 16 percent are full-time,
hospital-employed physicians; and 4 percent work for a government agency. The survey also highlighted the fact that ACS
Governors work in varying types and sizes of hospitals—most
of the Governors ( 62 percent) work in academic, quaternary, or
tertiary facilities; of the remaining Governors, most are at large
hospitals, rather than small hospitals (see Figure 3, page 29).
Given these practice types and institutional affiliations, it is easy
to understand why GME funding is a topic of considerable interest
to members of the ACS Board of Governors. But ultimately, GME
affects all of us, as it is used to train the surgeons who will be providing care to surgical patients in the years to come.
GME funding: How the system works
The U.S. physician workforce has always been considered a “public
good.” A goal of the GME system is to train the proper number
and type of physicians who can meet the health care needs of our
nation. In training future physicians, however, teaching hospitals
incur costs beyond those associated with providing patient care.
To address this situation, the Social Security Amendments of 1965
established the Medicare and Medicaid programs, including provisions that mandate federal funding for GME. Due to the public
policy-based nature of these monetary provisions, any changes in
public financing of GME requires a change in legislation. The most