Children’s Hospital Graduate Medical Education (CHGME)

Summary

The Children’s Hospital Graduate Medical Education (CHGME) program provides direct financial support to children’s hospitals to train medical residents and fellows. The program is administered by the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) and is authorized in Section 340E of the Public Health Service Act (PHSA). CHGME receives annual discretionary appropriations and received $299.3 million in FY2017. The program is currently funded under the FY2018 continuing resolution (P.L. 115-96) until January 19, 2018. The program’s appropriations are authorized through FY2018.

Hospitals typically receive support for graduate medical education (GME) through Medicare, and those payments are provided to hospitals based on their Medicare patient volume. Because the Medicare program is used primarily by people who are over the age of 65, and children’s hospitals treat primarily people below the age of 18, children’s hospitals have low Medicare patient volume and receive few Medicare GME payments.

Prior to the CHGME program, advocates argued that the lack of direct federal support for GME in children’s hospitals impeded the development of the pediatric workforce. Program proponents argued that children’s hospitals, rather than general hospitals, are more likely to have the patient volume necessary to train pediatric subspecialists. Since the program was created in 1999, the size of the pediatric subspecialty workforce has increased. The CHGME program supports the training of nearly half of general pediatricians and more than half of all pediatric subspecialists. In the most recent year for which final training data are available (FY2015), the program provided financial support to more than 6,800 medical residents and fellows. In FY2017, the program supported training at 58 free-standing children’s hospitals located in 29 states, the District of Columbia, and Puerto Rico.

As part of its potential reauthorization of the program, Congress may evaluate a number of related policy issues. These include, but are not limited to, whether the program size is appropriate (i.e., whether the current number of residents trained is appropriate to meet the current and future workforce needs), whether the program’s level of support per resident is appropriate, and whether the volume and type of information that the CHGME program collects is appropriate and being utilized effectively.