Declining reimbursement for graduate medical education (GME) as well as increasing hospital competition has placed the cost of GME in the spotlight of institutional administrators. Traditional hospital-generated cost center profit and loss statements fail to accurately reflect the full economic impact of training programs on the institution as well as the larger community. A more complete analysis would take into consideration the direct, indirect, and “intangible” benefits of GME programs. The GME programs usually have a favorable impact on the trainees themselves, the sponsoring institution, the local community, university sponsors and affiliates, and the greater community, and all of these areas need to be considered in the economic analysis. Complete analyses of programs often demonstrate very positive benefits to their sponsoring institutions that would not be recognized on simple cost center profit and loss reports. Studies in the literature that quantify the net economic benefits of GME programs are consistent in their favorable findings.

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The NIPDD 9-month fellowship provides instruction, education, and formative experiences designed for family medicine physician educators to enhance and develop the knowledge, skills, and attitudes to be effective leaders as directors of residency programs. 1 Historically, postgraduate training program directors in family medicine faced many challenges without signifi cant training in fi nance or administration. For those reasons, and because family medicine directors might not have support from other program directors, the sessions on stress and burnout were always full at the Program Directors Workshop. In 1994, during a strategic planning meeting of AFMRD, the idea of a school for program directors surfaced. At the same time, the ABFM was seeking a way to educate program directors on policies and procedures to assure resident eligibility for the certifi cation exam. With major fi nancial support from the ABFM, the idea became reality. In-kind staff support from the AAFP and AFMRD, and the interface with AFMRD, AAFP, STFM, RAP, and ABFM initiated the creation of the Academic Council by selecting representatives of those organizations to participate as members of the Council and to teach in the fellowship. 1 The Academic Council reports to the AFMRD Board of Directors through the Council Chair. Each element of the fellowship receives CME credit from the appropriate medical specialty organizations and the American College of Physician Executives (ACPE).

Health care reform depends on reducing inappropriate utilization and improving access. Elderly people, major consumers of primary care, are a place to begin reforms, but progress has been slow. We combined primary care screening questions for objective (medical condition as wellness) and subjective (perception of health as worry) health in a study of 767 elderly people in Youngstown, Ohio. The worried well (31.2%), a group likely to consume medical care inappropriately, and unconcerned ill (4.4%), a group likely to avoid seeking necessary medical care, account for more than one-third of the elderly. The unconcerned well (57.0%) and worried ill (6.9%) pose fewer problems. Family physicians can predict utilization and access problems for targeted groups (older people, minorities, and women), along with health beliefs and other indicators of health status. Although findings in this study are preliminary, they do point to positive uses in health policy and patient management. Extensive usage of the sure would require financial reimbursement to health care providers.

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