• Issue Brief
  • January 22, 2016

Children's Hospitals Graduate Medical Education Program Overview

The Children’s Hospitals Graduate Medical Education (CHGME) program advances children’s health by providing funding to independent children’s teaching hospitals to support the training of pediatricians and other residents. The program has been a major success and is critical to protecting gains in pediatric health care and ensuring access to care for children. 

CHGME success

CHGME ensures general pediatricians and pediatric specialists are trained to care for children in communities across the country, covering everything from well-child visits to the most complex cardiac surgeries.

The 57 hospitals that receive CHGME funding, 1 percent of all hospitals, train more than 6,000 full-time-equivalent residents annually. They train nearly half (49 percent) of all pediatric residents, including 45 percent of general pediatricians and 51 percent of pediatric specialists. CHGME has also allowed children’s hospitals to increase their training by more than 45 percent since 1999 and CHGME recipient hospitals have accounted for more than 74 percent of the growth in the number of new pediatric subspecialists trained nationwide in that time.

While much has been achieved under CHGME, much remains to be done. Many children still face tremendous access-to-care challenges due to national shortages of pediatric specialists. Children’s Hospital Association survey data has found a strong connection between pediatric specialty shortages, long-term vacancies and children’s access to timely and appropriate health care.

By strengthening children’s hospitals’ training programs and the nation’s pediatric workforce, CHGME benefits all children, not just those treated at independent children’s teaching hospitals. The CHGME program is especially vital because freestanding children’s hospitals receive almost no Medicare Graduate Medical Education funding, the primary source of federal support for training the physician workforce. Additionally, other potential sources of financial support for training, such as Medicaid Graduate Medical Education, are not available to many children’s hospitals and cannot provide training on the scale necessary to meet workforce needs. Even with CHGME funding, each of the participating children’s hospitals invests significant resources into the success of this program.

Background

CHGME was enacted in 1999, as part of the Healthcare Research and Quality Act. Prior to the enactment of CHGME, the number of pediatric subspecialty residents in children’s hospital residency programs declined in the 1990s and the Future of Pediatric Education Task Force reported that the lack of federal graduate medical education funding for independent children’s hospitals was a major threat to the future adequacy of the pediatric workforce. Congress passed CHGME with broad bipartisan support to establish a dedicated source of GME support for independent children’s teaching hospitals and improve access to care for children.

Program appropriations and authorization

Unlike Medicare GME, which is an entitlement, CHGME is funded through the annual congressional appropriations process. Fortunately, Congress has shown continual bipartisan support for the program, appropriating funding every year since its enactment. The CHGME appropriation funding level for FY 2016 is $295 million.

However, because total annual funding for CHGME is capped, children’s hospitals receive considerably less on a per-resident basis from CHGME than adult hospitals receive from Medicare GME, with CHGME currently providing only approximately 45 percent of what Medicare GME provides per full-time equivalent resident.

The Children’s Hospital Association asks Congress to provide $300 million for CHGME in FY 2017 based on the continued growth of the children’s demographic in the United States, as well as continuing needs in the pediatric workforce, with respect to sub-specialty shortages in particular.

Congress has reauthorized CHGME three times, each time with broad bipartisan support. On April 7, 2014, President Obama signed S. 1557, “The Children's Hospital GME Support Reauthorization Act of 2013,” which reauthorizes the program through FY 2018.

Association Contact: John Knapp, (202) 753-5366