Assume the Board has asked you as a Trustee of a medium-sized rural hospital, to develop a presentation on the process of starting a residency program in primary care/family medicine.
Develop a detailed PowerPoint presentation and a written executive summary on the residency startup process, as well as the institutional obligations of the hospital as the sponsoring institution. Your PowerPoint presentation and written executive summary should address the following points:
The rationale and justification for starting a residency program.
The obligations of the hospital as a sponsoring institution.
The process by which the hospital might receive federal funding for the residency program.
The financial commitments of the hospital, both in the startup phase and after the program has received federal funding.
The measures and methods for evaluating the performance of the residency program.
Rationale and Justification: The U.S. faces a severe and growing shortage of primary care physicians, particularly in rural areas like ours. A residency program directly addresses this by training doctors specifically in the context of rural healthcare, which significantly increases the likelihood of those graduates remaining in the area to practice. This enhances our ability to recruit and retain high-quality staff, improves community health outcomes, and elevates the hospital's reputation as a teaching institution.
Institutional Obligations: As the Sponsoring Institution (SI), the hospital assumes ultimate responsibility for the quality of the educational program and the well-being of the residents. This includes securing initial accreditation from the Accreditation Council for Graduate Medical Education (ACGME), maintaining a safe and appropriate clinical learning environment, providing necessary resources (faculty, library, simulation), and ensuring due process for residents.
Federal Funding: The primary source of federal funding is through Medicare's Graduate Medical Education (GME) payments. These include two parts: Direct GME (DGME), which covers residents' salaries, benefits, and teaching costs; and Indirect GME (IGME), which covers the increased costs of operating as a teaching hospital. The hospital must apply for a Full-Time Equivalent (FTE) cap, which locks in the maximum number of residents for whom Medicare will provide DGME funding.
Financial Commitments:
Startup Phase (Pre-Funding): The hospital must bear all initial costs, including hiring a Program Director and essential administrative staff, obtaining ACGME accreditation, developing curriculum, and purchasing technology. This phase is entirely funded by the hospital's operating budget until Medicare funding is secured.
Post-Funding Phase: While Medicare GME covers some costs, the hospital must still cover expenses beyond the capped FTE amount, pay for capital improvements, and fund specialized educational resources. The hospital must be prepared for potential shortfalls, as Medicare GME typically does not cover 100% of the total program cost.
Program Evaluation: Performance must be measured across educational, operational, and financial dimensions, including resident board pass rates, resident-reported satisfaction, and the program's success in retaining graduates within the local service area.
🖥️ PowerPoint Presentation: Launching a Primary Care Residency
Slide 1: Title Slide
Title: Strategic Launch: Family Medicine Residency Program
Subtitle: Addressing Rural Healthcare Needs and Building Institutional Capacity
Presented by: [Your Name/Title], Trustee
Sample Answer
Executive Summary: Establishing a Primary Care Residency Program
To: The Board of Trustees, [Hospital Name] From: [Your Name/Title], Trustee Date: October 10, 2025 Subject: Rationale, Process, and Financial Obligations for a Family Medicine Residency Program
Establishing a Family Medicine (Primary Care) Residency Program is a critical strategic imperative for our medium-sized rural hospital. This initiative addresses immediate operational needs, fulfills our community mission, and serves as a long-term economic driver.