Making a Business Case for Investing in Graduate Medical Education

Graduate medical education (GME) is ultimately an altruistic endeavor to educate the next generation of physicians. However, expanding a current program's size or starting a new program requires significant resources. It may be difficult to attract the attention of an organization's leadership and secure required funding, given expanding organizational needs, small profit margins, and fierce competition. Thus, GME leaders are often asked to write a business case for major programmatic changes yet may have limited knowledge and experience in this area.A business case (the justification) with a proforma (the dollars) conveys your "ask" to leadership. Providing the financial justification for undertaking a project, this proposal evaluates the benefits, costs, and risks of alternative options and provides a rationale for the recommended solution. This Rip Out focuses on requests for a new program or complement increase, but the basic structure of a business case remains applicable to other requests.Review the Accreditation Council for Graduate Medical Education (ACGME) Specialty Program Requirements for the new program or a complement increase. Note the requirements that entail resources, including clinical and nonclinical personnel, types and numbers of patients, equipment, travel/supplies, and physical space.Identify stakeholders associated with resource requirements. Include representation from those who will be affected by increased resource needs and less traditional areas such as facilities, finance, community partners, compliance/risk, patient relations, government relations, physician recruitment, and strategy/marketing.Meet with each stakeholder to obtain their perspectives. Identify how your request can drive an existing organizational priority. Recognize that GME increases may be primarily viewed as an expense. Present proposals as a catalyst for an organizational strategy.Identify who can provide needed data. Finance can supply federal direct graduate medical education (DGME) and indirect medical education (IME), state funding, and patient services revenue projections. Physician recruitment can offer anticipated workforce projections, with data regarding the average age of physicians in the specialty and national and state needs. Finance analytics can offer operational expenses.Develop a proforma which is a depiction of the projected revenue, expense, and operating margin over time. Identify your organization's budget timeline and Centers for Medicare & Medicaid Services cost-reporting period. If the timelines for the fiscal year, cost reporting period, and academic year do not align, create a unique financial proforma for each. Leadership often prefers a proforma aligned with the organization's fiscal year.a FY columns typically continue out for 4 or more years.Abbreviations: FY, fiscal year; PGY, postgraduate year; FICA, Federal Insurance Contributions Act; AMA, American Medical Association.Note: Fiscal year alternatives include academic year or cost reporting period.