everyone Welcome to our let's see this is our first meeting 2025 so of The Graduate medical education board we have some folks online um so welcome and welcome to everyone in the room we have some public members and and board members so good to
see everyone so uh I'd like to go ahead and call Mee to order and ask Lucas if he would mind doing determining our Forum um Andie zagel pres okay Dr CLI Knight here okay um Eric
Davis I see him there he is all right um Dr Grace will not be joining us today uh Dr Troy here okay Kelly kic will not be joining us today nor Dr gki um Dr shley hello here okay uh Rob mclin will not be
with us today Dr Becker here I'm here sir also here okay so we have six so that should be a quum okay fantastic um let's go ahead and uh first item on the agenda today is
to review our minutes from last time and uh Lucas circulated those in the packet that you all received and there so just comments edits revisions if not I'll entertain a
motion thank you to approve the minutes all right any discussion all in favor of approving our minutes from our October meeting say I or raise your hand I any oppose all right minutes are approved thank
you um okay new business uh I think we have to address every year the uh the role of my role as chair or the that position so I'll turn that over to our team at the commission could you explain process a little bit as yeah so the
board has I believe since it's Inception um operated um under a oneyear uh chairship so um that cycle uh commences at the start of of each year um and so
do we have a okay perfect so we do have a forum to vote to vote yeah do we I mean just want to open it up right for anyone who would yeah if there's anyone else who would like Toom that's that's
available just offering I'll Dr yes I think do I have to offer the motion or was the chair I have no clue yeah we' never had a vice chair umove all right um so there's a motion
to approve but there second Dr Troy motion second Dr Knight okay great and then I guess yeah all in favor all in favor I I pretty
unanimous okay that was a little awkward but we got through okay thank you so much on that for next year it's okay no worries um no it's part of the formal process that we have to go through every year so thank you and I look forward to yeah another year Serv as care so thank
you um okay other new business for today so we're on our new you know our new calendar cycle that we've been on for about um you know roughly the past year and that that puts the business of today meeting on reviewing the program development uh reports the reports that
those programs have sent back to us Lucas did a nice job reaching out to those specific programs and getting some feedback on their current progress and then um should they be in the right timing then they we would kind of guide them toward the expansion grants uh for
ongoing um ongoing Grant support should they so choose so I'll turn it over to Lucas to run through these uh progress reports make sure I am sharing the screen with the virtual members virtual members are you able to
see that okay great um so this should pretty much be the same format of Grant report that we had or the board had last year um and there are three grants that will be focused on today um the first is
Methodist Hospital Family Medicine based in Gary um this was approved in November 2023 this will be finishing this year um not acj approved as of yet but looks like it was submitted um pretty recently um the one outlier I would say for this
grant compared to the other two is that they still have quite a bit of their money remaining um so I've been in contact with their um program coordinator Andrea Williams um and so we've had some discussions and how to spend that down um report that to the board by the end of this fiscal year
um June 30th 2025 um you know there are quite a lot of details about their program development and director development what the board like me to read through those um I also will send this out I just don't want to spend too much time on yeah go ahead
yeah I'll just clarify they have submitted their application to my office we have not yet approved to send to acgme uh there are there are several steps I think just from the perspective of it's It's restarting a new program and things like that but it will get submitted to the ACG in hopes of being
your C okay perfect um yeah so a little bit of a narrative there um this was the budget that they had submitted like I said there wasn't a whole lot to report as of yet um so the board can expect something honestly I'll probably put something
together for our next meeting just for a little bit more insight on what this looks like no significant rep challenges reported um and then second Point what Dr Troy just shared with us okay I think uh one thing from a family
medicine perspective that they have they have had challenges with and we have resolved but the availability of Pediatrics training particularly impatient Pediatrics training Statewide is pretty limited uh and so as we consider new Family Medicine residencies in particular I think that's going to be
a bigger problem than we'd like it to be so I would comment thankfully the acgme loosens some of those rules with the last generation for medicine so there's a lower requirement for p education they took
away mon this last time yes there's just not that many paent units Statewide uh one of the advantages that we actually have is that Pediatrics program requirements decrease the Pediatrics if there's a p program
they're hungry for more invent work relas um and so nothing so we'll have to come to Riley actually to do their p um as well we accommodating our own programs first but just you think as we
think about and there's also competition with medical students too because they all need need those experiences so they try to think outside the box and using maybe nuu experiences ER experiences things
like that have been kind of successful ways to have a I think nationally that continues to be the number one citation that Family Medicine residencies receive are number one and two are usually P's and OB
[Music] yeah can we um just look at the T can you go back to the timing of this so is there are they they're not expected to they're not going to recruit for 25 so that would be 26 would be the first time they could
apply for in theory expansion right so there's going to be like almost like a gap here for that that which hasn't I mean that has happened before so that's not new um so I'm glad that Dr toy was able to provide that that Insight okay right um any questions on that that
was the few slides for that first program yeah and that helps us with timing and projecting out the future of some of the expansion gr applications we expect here that's a good point okay um next would be um Internal Medicine I USM
Bloomington Bas in Bloomington um approved for funding in October 2021 I believe this um program had a little bit of a delay that the board um discussed and approved um two programs that follow this um application originally submitted
12 17 2024 um sets run through the next year um the one point between this and the next program is the the funds have been fully spent so um that is something I am glad to see that that's been pushed all the way through um by June 30th program they have going back they have
three years it looks like we extended them a year yep um Dr Wilson and Tess warts are their notable contacts for that um this was the professional development timeline that they provided with us um
I don't totally know what it's all talking about in there but that's what they reported for us yes I can fill those details too um they have a second visit February 5th uh they will also be recruiting for a class to start in 26 perfect
okay this is the budget that they had submitted and I'll if I haven't already I'll send all this out to the board to look at this more deeply um and then they reported delay um in finding Dr Wilson as their their significant challenge for this
program so um any any questions any other things to point out before we move on to this third program these are pretty brief updates the outcome that they provided us with and I would also ask um if the board is noting anything that might be
missing from this report um I'm happy to program that in for the next round 26 now I guess um and then emergency medicine very similar provisionally improved in 2021
um funds have been fully um invoiced um give you the update on that actually had their initial site visit and did not get approved the progam director Dr hbert uh had was the previous program
director at uh here in Indie uh and has essentially started the program laid the ground with they have sort of a program director in waiting and she didn't meet all the criteria and Butch uh met the criteria but was not credentials there uh that was anticipated because she will
make me the criteria when the residents actually ared uh the ACG me did not like that uh and so they withheld accreditation on the first round uh since and they also didn't necessarily like it that they were going to be the only program in that hospital again it used to be a
requirement for for I to also have another program in the same building uh and that's not necessarily a requirement but nonetheless they sort of are holding us to that so uh they have had their second site visit resubmitted bush has
credentials he actually works there it's you know a bit more eyes fully fully dotted with dark print uh and um and so I don't anticipate any troubles but their program I think the EM programs are
great uh and and I am program are GNA be really good so I'm excited about them uh I'm sad you know G May a slow down but whatever we'll get there yeah so all of these will start in
2016 so that will put a significant I don't know what number of Learners that is or residents but you know that for our projecting yeah okay great submitted budget the initial
Challenge and then the the outcome that they've recorded for us um so a brief update but um that is those are the three programs that'll be finishing here this statical year so any any questions um any discussion before we move on to the next
item any anyone online don't want to forget people that are there bring done okay great and I think we're ready for the next item on the agenda yeah so the next item on uh on today's agenda is to
talk about the scoring subcommittee um Lucas gathered a small group of us Dr Knight Dr Becker Dr shley uh myself we we went through the scoring Matrix because you know as we have uh come upon the time where now the amount of Grant
requests that we have are exceeding our current Appropriations the scoring Matrix which is I think you know pretty solid but yet has some limitations and we wanted to try to address those and make sure they were um shorted up as
much as we could as we go potentially go into the future where uh the scoring Matrix will really determine which Awards go to which program um has not necessarily been a driver or a tool that we've had to lean on that heavily yet
because all of our grants we have been able to successfully fund up to now but looking to the Future that that is a little bit more in question and so um the I think the overall and i' invite Dr Nik Dr chy and Dr Becker to to chime in here as well as Lucas uh you know some
of the things that that we spoke about was making the scoring much more objective than subjective we have a couple buckets that are very uh vague in terms of you know what is a collaborative and that's 20 I think 20 points for that portion of the score and
the strength of the application are probably the two most subjective portions of our scoring Matrix and so what we wanted to bring to the group today was just uh our initial the subcommittee's initial thoughts and get your reactions Lucas is going to present
some of the uh recommendations thus far and you know we've got a little time we don't have to necessarily make a motion today we there's some more recommendations from the board and then we can um can further refine it we have we probably would want to approve next
meeting any updated scoring Matrix so that as we go into July which is our time when we really are going to have all of those expansion grants you know one to the other to the other sort of competing for each other um potentially depending on the fiscal situation um
that you know we have a little time to get feedback I think that's the main goal today is to get feedback and help us refine as we look through what the subcommittee talked about um anything any of our subcomittee members want to add to that I think Lucas will run through the Matrix here yeah um I so I
believe there are yep five recommendations um that the committee had come up with um the first two are probably the most consequential and impactful um the first being um the section involving a collaborative approach um such as the Consortium f2c
hospital system foral access hospital or other um currently it's it's up to the discretion of the evaluator up to 20 points um the committee proposed making this a tiered system and defining what those collaborations eligible
collaborations are so that you know if one application has an fqc and a critical access hospital they can receive 10 points um up to 15 um anything beyond that is just chry on top um this would also decrease that score
by Five Points um you'll see later on one of the lower um recommendations is making all the applications an even 100 than having two of them 105 that would also fill that objective um So currently the
list that I have for involving a collaborative approach um critical access fqc behavioral behavioral health provider a medical school or a rural environment can award up to 15
happy to accept feedback or thoughts from the board we need to be more specific than a rural environment wonder I'm not sure what did we mean by that they were a rural setting or with the rural Health Centers
I wonder yeah partnership with a rural I can't recall yeah we can we can we can refine it however we want yeah to make it it specific and I I think that's the objective of this discussion today is to really hash out the yeah what other partners are
we not include that that do all think well do you want to specify or just say other that provide you know clinical experience and then have the application support just so it's what what I heard
from the the committee was that the the goal is that the applicant can pretty much determine what their score will be when they submit it um so just trying to be as clear as possible but we do have that other score right that that it's based on the
density of the providers in that area so there's that underservice so we don't probably just want to say rural or under serve because I think that other squ maybe all getting at that am I am my and perhaps just for reference this
is this is what the board and see if I can make this a little bit biger for you this is the outline of the current application um so program is in an underserved um area that's determined by the Robert wood foundation um the
population to phys ratio that is the second pre-calculated uh involving a collaborative approach this is what we're talking about right now priority score for five um year or newer programs predetermined and then strength of
application so those are the components this is where we're focused up them yeah likely the first two will get to it to some degree though you could be in a urban center and get some higher points for that that just is
underserved but it likely hits the rooll part pretty hard so do we want to double that triple dip that right little so we could based on feedback unless others have sending opinion we could take out
that that bullet thatment yep so then I would have four critical Access fqc Behavioral Health provider and medical school and they just to get all the points I just need at least three three I think we could
add rural Health Center because that's different didn't and so but I think that that's a good collabor and then some of the rural communities I believe have like a um Foundation have foundations in their communities and I see a partnership with
a local Foundation um as being a good sign that you got support from the community that you're in and would be an important collaboration so I think that maybe we need to have sort of a other and let them fill it in and then we can
sort of bet that if it's something we aren't thinking of now I don't know well that's I was also thinking about rural areas then and I'm still trying to get to know different residency programs all throughout the state remind you my frame reference is Prim County which but in
the rural areas would it would it be harder for residency programs to bind the free collaborators you know I is that is that a barrier just because of where a program might Te You graphically me it's sort of an indicator
why they need more collaboration exactly that they're thinking of who else can we work with to make sure we have the resources we need to be able to but that would be for me a reason to put in other category yeah see what I'm saying let let us give them points if they
demonstrated thinking outside the box to me it World me because it may not be already existing it could be another hospital not necessarily critical access hospital but um if you're in a community that has a couple of different Health Systems
smaller Community you may need to rely on the other health system for your geriatrics or your mental health or something uh experiences and so being able to say you've got a collaboration with um an adjacent health system or
Hospital might that sort of I think meets that Spirit as problem I I was wondering a little bit from a rural standpoint where people are under serves already in the position to be ratio is low do is there capacity to teach and how do we assess
that I I realize it's a long-term investment but it's in the moment where we have to make sure that I I think we kind of on whether they getg accreditation and meet the requirements rather than us trying to
make a determination of whether they're going to be able to meet the requirements because I I think as I meeting me requirements I don't think it's our place to say well we don't think they're going to be successful so we're not going to fund them they
already requ that push and cool that you're talking about though I I do hesitate sometimes are they going to be able to give a quality education uh I don't know it seems like we need to
sort of trle Blaze forward though or we're probably never going to move the but I think that's we sending the message that you got to you got to have some collaboration if you're trying to do this all on your own you're not it's less likely um and hopefully they using
the discovery Grant they they come up with that decision before they actually move forward with but sometimes it's not until the program development stage where they recognize that and you know they don't have to get 15 points to get an award either they
could get entally you know they don't it's not a requirement to fulfill all those 15 points it'll make their application more stronger obviously but it's still very possible that someone will get through with lesson three
collaborators Dr Becker was yeah Steve do you have anything else to add no I don't know if he can hear us Dr Becker can you hear us you're on mute say my it froze for a second sorry I'm back
um no I think you know I think the key is to have something that is somewhat measurable um and you know in my own personal view I think the rural area such such underserved as is in our state that we definitely have to have that as
a major category but I did like you know we discussed of trying to leave it somewhat open so that different kinds of collaborations that maybe we hadn't thought of could be included um I'm not sure this one is right there yet I I think we need some
more work on it okay okay so it sounds like there's General agreement though to refine that a little bit and maybe have another category or some other criteria better defined but people are uh like that you guys in general like the more objective
approach for this scoring yeah and is the board comfortable yeah with the tiered um than just giving the score okay to Dr her's point though if some no one has ever gotten the Perfect Score I think coming through on our scoring system so for somebody to get under that
probably is not going to keep them out I mean clearly it's if things get more competitive it will feel different but um hopefully uh yeah there's there's wiggle room for not a perfect score okay um the next recommendation of
the board um was to kind of I guess solidify and confirm what um you know strength of application or completeness of application looks like so this is the second area that the board has discretion over um let's pull this sheet back up just for
reference so this is the final area um up to 20 points um and so essentially the way I've interpreted is is how many letters of support or different documents are included in that application um and so I think you know
for the grantees or the applicants perhaps there's not a whole lot of clarity on what that actually looks like what the scoring basis is um it was proposed to the board that you know they Define what those actual documents are so a letter from the Dio for example and
also do a teer system up to 20 points on acceptable documents [Music] yeah so here I think we want to talk about what would be the checklist items that yeah I think we feel less complete
on this one than we did on previous one again the the concept was at least for me having scored these for a few years I always feel like I get to this one and I'm like you know is this a 15 or 17 or I don't I don't you know it's like and so just trying to be
more uh defined and how you earn those 20 points yeah again so that when you're putting the application in if what we expect is a letter from medical staff leadership uh Hospital Administration somebody in the community
we should sort of be able to put all those things in and that way people aren't guessing well who who do I need to to show the support from or um that we're down the road where we need to be at this point so I guess that's the question is what what from a
completeness standpoint would we expect and this knowing that couple recommendations down we're limiting it to 50 pages so we don't get any more of the 275 everything that said anything everything you think would
be yeah so no more 90s no more I think we need the no but I mean that's probably It is Well I think again that's the thing is it appear to be nice to delineate what we expect in a complete application
that we can right so yeah decide how many points you get based on whether you made those things that we spelled out yeah are there are there any documents that the board would expect to see in an application that I can go ahead and jot down today for an upcoming meeing of the
committee I don't know it's that one thing that the ACG doesn't really ask for until they come for your site visit is back development plan and as a working with new programs if there's one thing I've now started pushing my programs on it's it's that uh especially
when they're new sites that it doesn't have to be long it just be something and I'm open to criticism on that that's part that's part of it and having that you have to document that every year in you're reporting so
getting them yes but you don't have inial application I don't feel like that's one thing I that's not of bad yeah again I think a letter from medical staff leadership saying medical
staff is supportive of this and and maybe that's where you even include some of like that including bring helping get people up to speed to feel comfortable teaching but an Administration with some both sort of philosophical
commitment as well as Financial commitment um and U again it feels to me like something from the community saying like to have this residency in our community where're as a community whether you know it could be from the
Chamber of Commerce or the mayor of the town or something like but it feels like there are a few things that we could delineate that would help us all help me feel better when I look at it that okay this isn't something that somebody's just slapped together as an idea and
they want $500,000 over two years um but they really don't have the support they need to even get started maybe they should get one from their state legislator from the local area so they're aware of the value that's not a
bad idea um anyone online Dr Becker any any comments recommendations the state legislature is brilliant um sort of free advertising that is that is actually
pretty pretty pretty either your state representative or your state senator or that make them aware of the the fact that yeah there's a position shortage in this area we want to start a program we need support and if they support the GM
board getting the funding to give grants yeah yeah this is this is this is a breaker all right this is that gives us at least a few things so the subcommittee will probably meet once or twice between now and the um April meeting and refine some of these suggestions into making it more
objective I mean we didn't materially change the overall structure and we really did I think the structure is pretty good we're just adding granularity of these subjective measures to give applicants the most Clarity and ourselves the least
amount of uncomfortableness with uh you know making scores that then could determine big things for programs without um hard expectations attached to those scores and so I think this is a good iteration
yeah just one comment and then miss you have a clarifying question I think of the different buckets this is this is definitely the one that Dr got to your point we we should be discussing I think with the the letters you know making
That explicit and having it be all or nothing you know I think that's a total of of 20 points I had had seen so you know is that five is that 10 set that Benchmark I do have my question though the 990 that you mentioned is that
a financial statement or um I I just one thing I wanted to flag that maybe can can be further fleshed out by the the subcommittee is you know I think it's it's great that we're trying to limit the the the volume of pages for each
application but if Financial commitment is one of those criteria on which we're going to be evaluating um those applications that that could present a challenge and then you know thinking through what does that mean I mean the
applicants have final resources and like what what is an objective way through which to look at that what I would pull out of a 990 that would change my opinion one way or other I mean as long as they're nonprofit and they state they're not for profit we have to assume that they're doing the things that they
do what would you be looking for in a 99 I I don't I I don't yeah so if we're looking to reduce the administrative burden there is no way I mean you can say got a 50 page limit but then you're going to have to exclude certain
attachments find Budget we need a budget we need a budget and what is your contribution and so I think that that may be one of the objective a is a budget for how the money is going to be spent and what's your in kind portion that you have to contribute how because
it's 25% for some of these I don't know transer 25 and 75 but I think it is it's for the for the develop or the new program par do we have to we ask them to have 2 million and we have only five or we give them only 500 I
don't think that's a 2575 right and the in the application it just yeah I they have to yeah in the expansion in the expansion did they match a one to one in the program devel
the uniform match I think it's a program develop Grant the feil we don't probably ask them to yeah I don't think we well I think there is something in there organization I'm certain and we'll we'll
update the rfps based on what these discussions are so I will clarify that for you expansion grants I don't think it makes sense that as because they're all relying on CMS passrs and and those things anyway so I I don't think but the
program development grants we want to see that there's some commitment from the or financial commitment from the organization to match percent of what the grant is that they receive yeah well that's look at that 25% something like
that okay so yeah that would be part of a complete application I think that we would look for something very specific that here's the budget and here's the amount that the organization is investing correct versus not necessarily attaching their 9
yeah right yeah that's a good point 99 yeah I think they're trying to be helpful but we don't need all [Music] that okay so that gives us some granularity so we yeah our subcommittee will re reconvene for a time or two
between now and our next meeting and then we'll hopefully have something to U vote on next and take action on as a board in um our I think our April meeting was actually bumped up to early May because of a conflict of like May second something like that as I
okay um this was a discussion of the board um no no proposed changes and this only applies to feasibility and program development but the naive specialty or density of residency in the area um this
goes by the acgme website um it goes by um the next closest program and then the number of programs in the state um so that's how that's been determined so far um the board or the committee did not offer any changes to that um but just a
couple thoughts um including specialty into that figure U Need of specialty I had a brief conversation with Bowen Center about how to determine that not necessarily an easy thing to determine um so I think that'd be part of a bigger
discussion but update um recommendation of a 50 page P count um it sounds like that's popular with the board um so no no real change there um and then the the maximum score of 100 rather
than 105 for two of those programs okay um there was also discussion on moving forward rather than um you know programs that have been established more than 5 years ago receiving that Baseline whatever the minimum Point level is um replacing that
metric with a retention of physicians in the state um the determination of the committee was that um this is too early to implement something like that and these the grantees would need to have ample time to prepare for that but that was proposed to you know not penalize those
programs being established but rather give them something else to H for so I think someone brought up that other states have done something like this I can't recall which believe it was Wisconsin correct Dr Knight some kind of yeah
that's right wions does have a metric in some of their ongoing uh yeah what we would call expansion grants I think they have some different term for it but um to um you know sustainability grants or that sort of thing that they do have um
yeah they have a threshold that the program has to be retaining a certain percentage of their graduates in state for them to um continue to receive that Grant yeah that was offered as a replacement for that metric um sometime
in the future but nothing nothing at the moment so um what do inuse what do these recommendations look like here is um an application that was submitted several years ago and approved um we'll we'll
leave the name out but if the board wants to do a deeper dive you should all have access to the SharePoint site with um Linda bratcher's summary the abbreviated application and the full application if you would like to go through make your own determinations about best scoring
um you'll see the information from Robert J Woods I would have that program in for you um in this application they did meet um rural environment Behavioral Health provider and fqc so they would have been awarded um that full
amount originally accredited a long time ago so they are not receiving points for that um and so if the board was scoring this today they would have the latitude to reward between 45 and 65 points based on that updated scoring um and for
reference this this applicant has been awarded several times so um that provides any context what do we know what they did did when we did you that um I can go back and
look um like way off and way different now with our new scoring system like did it radically I can try and find that and do a deeper dive um and offer that the subcommittee meeting um not quite sure where I can find that but I'm sure I can
yeah I think we it might be in the minutes of when we approve those because we used to call out great well that will I think we possibly did that that be one point and then I guess the question is you know we have sent it out to the committee for the committee to do
their individual scoring but if we Define these things um so that they're more objective do they even need to go to us for scoring or will the scoring all be sort of automatically done and then we would have those scores when we
consider the application but um but then that would sort of take all the subjectivity out of it I don't know that's is that a goal of this you think for that I don't know I'm not sort of asking myself yeah it's I had really
thought of that but you're right if we make it so um defined defined yeah then we may find that individual story may not be necessary but we may want to go through a cycle of a year and like determine that like do we do we
have are we in agreement that this is objective or are we not um before we just give up the individual scoring but it'll make it easy right it'll make it easy it make it really easy for us to click and say do we agree or do we want to adjust right we be quite as invested
because we won't have to dig in quite as much and look at it yeah good [Music] question might be a little too autopilot to cruise control it's a fair question I think you
know but if we do implement this change we'll have it I think it's say we can discuss as a board how is that affected our engagement but but really I think it gets to what we want is that we want to make sure if these things are included
then we would consider it a good application not sure how that would help us then in the situation we recently had where we had to make big decision you know so I think I think the benefit
trying to believe me I liked it when you first talked about but then I thought what what happens if we don't have enough fun funds toward all the applications how will we sort through that well the default differentiators then become community um the density of positions um
the hips of the yeah shortage that becomes the differentiat if everybody's um applications are complete and they all get and they all have collaborators and they get the full points for that and it does fall back on these other things to be the differen
except that the what what I noticed with this is how how strong the year in the program so they lose 25 points because they're not a new program they might be a great rural program that's graduating people that practice in underserved
Indiana communities and yet if we're going to use this scoring metrics as the differentiation when we get to where we don't have enough money um are we going to be in a situation where you've got a program that's doing great doing what we want
and yet you know this may you know potentially make them drop their spots or even under Draconian situations stop the program so um I did like someone that made the comment in the past about at some point
when we can measure outcomes and how many percentage stay in the state that that might sort of erase the the 25 points or we don't make it so much um of a percentage of the overall score
yeah I mean they're good conversation points it's I I think yeah let's talk about it in the subcommittee I mean I think that that was the that that does drive a big that will drive that that newness of the
program would drive the most ongoing program expansion correct the only thing I would like this sub me to talk about more to consider or maybe kind of wait and see how things evolve is just let's make sure we don't hold the residencies uh accountable for things they can't
control for certain Specialties if we are losing certain Specialties we as one of them we're very concerned about by you know people might want to stay but they decide to practice outside of our state and I don't want to have a scoring system that penalizes residency programs
for things that yeah yeah but I do think we need to track if that is occurring so we can go back and show the day we as a board are kind of heal responsible that's one of the the outcomes that we will be measured on is
is they're giving us money to increase programs and and the attendance for day yeah and you know National Data shows it's it does work right that if you train in the
state you will stay at a rate of like 60% or 65 I don't know 16 17 something like that um but if there is a big Force that's you know a unique specialty that may not be have the same um draw to this
state for various reasons on our policy you know then then that may be one but that may help us tell our story too uh about why we need to you know why this The Challenge and we have to have different resources and models to think about because it it is hard to retain as
certain special the but I think Lucas you know as we go through our next iteration of our work part of part of Lucas's uh you know great work ahead I think is to try to help us really get granular with who are we retaining at at the individual level
from these state grants and and how can we tell the story are we meeting that 60 70% Mark with the use funds and uh what is the impact what is the true impact because we're making a a deduction right deducing that they're that they're
probably going to stay at that rate but let's we do want our actual data and then that could drive a change in what Dr brecker's talking about right it's that maybe instead of how new a program is it's like how many of them stay may be a driver that would be bigger uh for
us if we thought we had reliable data yeah well this is this is great feedback um it gives me a lot to to go off of for the next convening so um subcommittee members I will plan to send out another doodle poll to figure out what our availability is and we will get rotten
on this um are there any other board members that would like to participate in this upcoming meeting um I will make the effort to record it and post it in the SharePoint site so if you'll have some contacts before we get into the May 2nd meeting and actually the board votes
on it um and the and the invitation is open it doesn't have to be deed today yeah okay feel free we love more more more folks great um so I believe we're ready for our next item yeah absolutely so um the
next item I I and I don't know if Greg and Lucas I don't mean to put you on the spot but if you want to give like a higher level legislative and um you know physical Overview at all before we step into this conversation because usually we do kind of just talk about the landscape right now and the the
legislature is there anything you guys want to share about that before we dive into these specific topics of our recent presentations in that one pager jump in so uh the legislative session has begun and is is certainly keeping us
busy there have been northward of 2,000 bills filed um you know we're we're tracking close to 200 in the K12 higher education Workforce base um but what we wanted to share today just with regards to the uh budget bill um is that has
been um made available from the house um kind of going backwards and working to that um the state budget committee uh received uh economic uh forecast projections about a month ago um was not a surprise um with what was discussed
we've kind of known this for a while that the uh 2527 B in which we are are you know going to be entering is not as rosy as what um you know we had last time during the 2325 so um projections you know some some modest growth in thisal year 26 things will Flatline in
this of year 27 um from there you know the the uh government is reacting the the BR Administration uh proposed their uh recommended budget about a week ago um you know there there are cost saving
uh measures that are within that in a number of places including with our agency um and and kind of across the board I know we have Brook from the Department of Health joining us and um you know the the administration is very attuned to that that phisal Outlook and so um focusing on efficiency um and cuts
um across state government um you know kind of minimum 5% that that that fluctuates um in some cases so that is you know just to be kind of uppr um not trying to be a wet blanket but um just you know those are the the fiscal um
realities that we're we're encountering so um in the proposed um Governor's budget we were listed at 7 million for this schol year 26 and 7 million for fiscal year 27 um that is the same um in The house's current budget and as the
board will recall that is the the thresholds at which we were funded um during the last bium so um we take that as a win especially knowing the um you know cuts to some programs that are taking place um I've said this many times and I'll say it again I think this
is a program that is you know not just strongly supported um by the administration but by um both the house and the Senate um in both parties and so we are fortunate to um have those um current thresholds in the house budget bill um and we will you know as we've
done in years past be be working with board members um you know for advocacy but um again we we are pleased where we're at um now and want to have ongoing dialogue with um chairwoman her and and the rest of you um as we you know kind
of navigate this legislative session but um you know in addition to that really appreciate some of the the advocacy that's been done by um some associations including those that are in this room um for funding so in addition to collaborating with board members will also continue to um work closely with
organizations who are supporting um the work that we do great and I think that's a nice nice um segue into a presentation that uh dror or chairwoman Hearn and I were able to give to the Indiana Business Health collaborative um jeez what's that two
weeks ago now 10 days ago um and so some of this is you know things that I think the board is familiar with um but then we we did a deeper dive on you know referring back to the original figure that trip unbo gave us um and trying to kind of give a
fiscal amount to what that would actually look like yeah and just a out a little bit like this collaborative um Julie Reed who's here from the isma she helped make the connection and an introduction for us to come to that meeting and that is a u a lot of people
were on on Zoom so I we didn't have as many faces in the room as I think what we would have hoped but people were attending and they very engaged during our presentation but that is a uh group of Business Leaders across the entire State who are very invested in improving
the health outcomes in the state of IND indana and are addressing multiple topics um and led by Luke Messer former yeah um and and so we were yeah thrilled to have the opportunity they
have already been doing some work uh as as a collaborative discussing the phys shortage and how important it is to improve the overall health of the state of Indiana and so we went and and I think we you know were able to with Lucas itself help Lucas did a lot of
work in preparing for this meeting for to to Really forecast ahead what is the big ask should we want to truly close the gap that exists between our state and our neighboring states in terms of the ratio of Physicians to population
particularly the residents the population I mean and thanks to Dr Knight for some of the flights he and data he had pulled to help us prepare for this as well um but it got a lot of attention um and soas well you run through the slides but that was the audience and it was you know multidisiplinary business leaders across
the state were were dialed in and and I just think very engaged and this is this is a slide Dr KN so perhaps he can this is the acgme on an annual basis uh publishes a data book and so this is all
from acgme data and when you look um yeah we rank number 46 in the country uh when you take the number of what are called pipeline residency slots so those are residency slots that lead to your initial board certification um and so those do not include
fellowships but if you just look at um pipeline residency slots based uh you know on population the rank number 46 in the country ahead of a few of the frontier States and uh otherwise we don't have actually any R so so yeah so
we're at the bottom we are at the bottom of the barrel and you know it's also reflected if you look at positions by number of positions by population of the surrounding states track with that as well so um yeah this should be I always
think this is like the most compelling slide you know are you proud that we're the bottom of the barrel and not then need to but more slots what down to that um no new information here um this is the figure
cited by trip unach during the economic impact study this was performed in yep 2022 you can see we're kind of coming up on the end of what that that figure is um this is driven by retention of Physicians and M stake um so you know
that's happening then this should be what happens according to trip on block okay um this is just a breakdown of the board Specialties but the Specialties that have received the most funding that the most being Internal Medicine um those
are larger U cohort sizes pgy um so that's anticipated on my end um family medicine has the most programs that have been awarded so that also makes sense and then Psychiatry which I think is due to a lot of the activity down in Southwestern Indiana um so just just
context on the activity of the board um since establishment um I cannot articulate the slope here for you that was performed by Excel but that is the anticipated upward slope of the cost of expansion grants if the board should continue to operate at
the the same momentum um that's projecting out to 9 million um annually um fiscal year 27 um clearly there's there's you know probably a bit up or down from that but that's just a projection um the board scene is support
nothing new here and this is kind of where I think we get into more of what the fiscal costs are um and that's why I'm glad Greg was able to share what that forecast is um for the upcoming bayum um based off of what I was able to find
from the the current programs it would cost the board about 13 million or 27 million for the banum to continue to support the current programs that they have that is also you know the program development grants that will matriculate into resting expansion okay um so that
is for over the Bia if the board wants to look at that original figure of a shortage of 8177 positions um we've funded um 265 so there's a gap of around 550 this figure
is looking at 500 um and just you know for kind of accuracy if we want to bake in you know some threeyear four year and five year it would cost around 74.2 million and this is not limited to the buy inm so I I don't want anyone to think that we need to have this money by 2028 or else everything ends this is
this is moving forward um so I guess maybe 80 million is more of a realistic figure if we're looking at 550 okay and then this third slide is just a comparison of what those three look like together so this is meant to kind of
stir some discussion among the board about the upcoming bium where we currently are um and the current programs um and then this just kind of gives an overview of what what that looks like
um but I think I'd like to kind of stay here and see if the board has any thoughts back up two slides from there just for a second because I think if you're I'm sorry one more than that sorry there um you know I think it's important if you are having
an opportunity to talk to any of the legislators there's this sense I think that all the money for things like this go to Indianapolis and and this slide is really very clear about the fact that the majority the vast majority of these grants have not gone to Indianapolis and
that they are serving outlying areas in the state um and I think that's important for this legislature to understand because I think there's this sense that well we've got this big State medical school and they get all this money and so why are we just giving them
more money and and this clearly I think shows that this isn't all this money coming to Indianapolis and so um it's just I think an important concept if you have that opportunity to talk to legislators cuz CU saying 7 million is not enough we need to go to 13 14
million a year sounds like well what are you doing with all this money um but you spend a few minutes sort of breaking it down where all this money's going and then again the tri trip bonach um multiplier effect you know um it it
starts to make a pretty compelling picture pretty quick the other thing that people were I think struck by that we spoke about when we presented at the collaborative is said this doesn't cover all the costs I think they thought like oh this is just free money and then you know we're sponsoring the whole thing
but they were like oh oh it costs more than this um to train a resident and that's interesting so we probably need to put you know a little bit more granular it was useful feedback because it's not obvious to them that it cost close to you know
$150,000 a year per rent amount or people more yeah you just shared an article with me the famous more like 2003 230 yeah um you know so the the 45,000 is just an offset of a small portion of what they're have these
health systems are having to go through and with the challenges financially that the health systems are having in terms of their margins and whatnot then it you know it does make it uh even all the more important that we have these funds to sustain and
continue is programs have to decide whether they can keep the programs going U so it was it was we got some really useful feedback as people listen in but politically hospitals and Health Systems right now high on theow for most of our
legislators so I think it is important to talk more about the communities served uh and the population served than talking about money going to hospitals and Health Systems that's that's not a real popular tool question about the the
the number for the shortage you know 800 or 500 whatever it is we're GNA go out and say the shortage is that um we looking at that and benchmarking it nationally and also
are we short in that number of PHS and also short in advanced practitioners as well and the reason why I asked for multifaceted um one you know Allen County and it we have a lot of resources
and it is hard to get to a doctor in Allen County you get to a a nurse practitioner or a physician assistant and if I'm thinking like a legislator on I'm going to lower health care costs that might be okay with you know I'm thinking like the legislator and I want
this board to be ready to kind of think through that and have a position be able to say because I'm a strong supporter of I love my APS but I also really believe we need to support expand in our resiny program and I'd like to be able to say
you have a gap in APS and you have this Gap in res so we can come in and still support this number whatever the number is but it's a real real fact that we have and also kind of maybe a growing resentment that Physicians are being
asked to to train their Replacements in some cases I feel like maybe I'm wrong but I feel like the legislator is fa supportive to positions um got
got at least one two positions in the legislature Dr Barrett and John Dr Johnson and for Wayne um so there's some support and they've been pretty supportive it all it's about money though and it cost more so do it cost
more to have all these residents they I what I really just want to make sure we know where we stand on the DAT of our state if it's what's the AP shortage yes can we come in and say look we have a shortage acoss so if they say what about
all these nurse practitioners and Pa because you got all the dads now on TV you know showing them as a a doctor option and so people people might think that and um we all know they're not and um that we need to continue to support
for the residenc it's been a couple years but I wonder if we could invite the B Center back to share their new I know they're they worked on a whole new set of data this fall um in some of the primary care Specialties um and it's just yeah it
would be helpful to have updated sort of projections from them because you know the other thing when we talk about new residency spots that's great but there's also a lot of positions leaving the workforce and there's a recognition that
somebody who's retiring now it's not a one toone FTE replace but a lot of times it's taking two newer Physicians to replace one retiring phys so there's a lot that kind of goes into all that kind of nuance but it'd be great to hear sort of yeah that's a good from the B Center
again it's that was helpful when they came a couple years ago I think let say the is IA the ifp do a lot of adting around value of training the
enh the number of hours of training that are put into versus yeah but it would be great to have our board be well versed in some of this yeah more current data so I think that's a great suggestion as you could reach out to the bow Center maybe I know
our July meeting be packed so if they are are available as soon as our may may early Maye help happy to great um and then perhaps something that's will just kind of help with know digesting
that um presentation um our creative director here at the commission has I think done a really nice job of updating what that one pager um data sheet flyer was um that was originally I think from 2021 um so there are there are some updates to that um and when we're
talking about not all the funding going to Indianapolis I think this you know is a nice graphic that can be supplemented too um and so this is all included in that packet that I sent out I'm happy to send out the file as well yeah it might be good for the board memb to have it to
share as a PDF individual PDF thank you I would have I would have printed it today but I think there is one edit that I would I'll ask um Doug to make is rather than saying slots created I would probably say funded um just because we cannot say that they were all created I think it's probably more saf say that
those it um that's the one edit that I planning to offer we talk about that number a little bit because I want to make sure I so when we say over 260 new Resident positions and 77 residency slots so Ian it sounds when when you say
say that it sounds like well there's 770 more slots now than there used to be well they we paid for those slot but it's the top number is really the number of like current residents individuals yep individual 770 is just is the
cumulative and that's including the general surgery and I think it's yeah I think if a family medicine is resident could have three slots because they would have three years right so one resident might be three resident slot correct or four or five correct correct
so that's a little confusing 770 sounds like 770 more people were trained and but more years train training years surge train yeah it's training years it may be worth even
taking the 260 is truly the number of individuals that have been trained this program so I I yeah trained or funded um additional that were trained as a result of fund yeah yeah because I think
the 770 the average recipient of this yeah I mean it's hard for us to even discern it I think for people who aren't well be confusing so we can just delete that well that that is also good feedback and I'm glad that we talked
about that here before we sent that and I'll tell you if you SL if you scoll down just a little bit I'm sorry scroll up sorry not good give a little bit further I thought that was cayen Clark first like really small on my screen and
I thought wow this is brilliant we've got yeah CL if you squint um well great I I appreciate that feedback and we'll we'll make that change with Doug um and I'll have that sent out here within the next week and board members would be able to use that
in any Communications moving forward yeah um yeah thanks for upd getting that updated Lucas because yeah that's been something I know we wanted to refine an update for a bit of time here and now it's like look really good very current and I think it'll be helpful for us in
these important conversations ahead I'm that on the second page that's the state that's got the Navy in Gray um how is it calculated that somebody is Navy I see the key that says impacted
does that mean a traine when they after words impacted um so those um some of those are from the previous document um that was from Eugene Johnson um so I was able to find that file that he had listed those counties um and then the
additions um are either listed in the application um that have been submitted or reported on the acgme website um so there's a partner site in this city or this I no V is gray on here but on the
other map it wasn't it it wasn't so the other map is where um the programs are based out of so you'll see this is much less sparse or more sparse I'm just surprised because I
think vgo is blue here did I see that right and it's gray on this one and I'm kind of like I wonder if the difference there is that the grant that Bingo got was just recently they got a discovery Grant they just got yeah this does not
include feasibility studies or well excuse me yeah I this does not inability studies this and perhaps that's a a good Clarity or clarification I should provide is that this is just based off the grants so anything that shows up on
these slides that look like they're from the commission are based just off of my master spreadsheet with Grant I just assumed everything that was on there would also show up on the other one so I when we did clarify that um at ibhc so
thanks for that we'll make that point moving forward so I would assume that some of the blue counties are considered in the service area of those Grant recipients and that's why they in the blue there's several but are
blue counties that I'm trying to figure out who claimed them based on the yeah and I'm I found that file um it was from a few years ago so I'd be happy to to grab that and send that out to the board so they can also look at it um is there
like a key the colors on that same one yeah what do the different colors mean darker blue um it didn't translate over from PowerPoint to so in PowerPoint fation darker blue is more funding that's been received okay
so it's just degree of funding or top end just over 10 million bottom end is a feasibility study um so you know the very very light Blues that's where you can expect you know one one study and not all of those continue to program development which why you
them um but those are the data updates um as of the last few months can I ask a question the second page of the flyer okay seems like there are several sigc Internal Medicine there like four times one is prelin but there's three of
them then I wasn't sure about that and then also I wasn't clear about some of the there are a couple of Indianapolis I program site in emergency medicine perhaps that was well before my time on the board most like but I was just curious about those those were also before my time um so a good amount of
this blue um is inherited from the previous one they were expansion they were expansions the and the expansions I see so then like every time I expanded then we add them to yeah we
added we helped them had slots yeah so maybe they were from a class of eight to n something yeah and they got a gr for that and so that was a newr it's not one that we persistently give that those doesn't seem like they haven't come back
and continually reapply okay sure um and I'm not quite sure what it would look like but if if the board wants a full list of grants that have been awarded I'm happy to give that um I have Greg and I have quite a bit of access to
our Master file um not necessarily easy to use but there's a lot of information there that maybe the board doesn't have as much access to um so I'm happy to kind of break down some of those walls and try to give some more context yeah I don't know if another column there would help or not number of
Learners and number you know then it might get kind of confusing but at least just for us for our legislators right know what we're talking because some of them were one oneoff some of those are oneoff like the preim year that was a one off year
that we just approved it when we had funds and then we decided you know what this isn't really the purpose of this and then we didn't continue to fund that is an example I think if I remember that correctly so you know and there were some that they applied and then they
applied for a year to expand and then they didn't really come back again to it so uh the impact is yeah the degree of impact and the degree of residence is really not conveyed here it's more absolute yes would anybody be interested in a map
currently with impacts yeah so something like this this is great for historical the show work because I would think the goal would eventually all blue right but I mean it also would be helpful to have something where our dollar Ser coin I
could provide more context if that was the situation um because a lot of this was before my time last February um any any feedback online Dr Becker yes this is from earlier just so
the board knows that $45,000 per resident amount that was um settled on by a Workforce um that helped get the bill originally passed that was led by the Indiana Hospital Association
and the 45,000 was a sort of a national figure of what the average Hospital lost in training a resident the deficit for programs to be run at the average hospital and that was including with CMS
funding and without CMS funding so that's where the 45,000 came from um and it was always meant to just sort of incentivize hospitals to be willing to take on residencies in our state um so
that they wouldn't walk in always knowing they were going to lose 40 or 50,000 a resident um so that's the historical part of where the 45,000 came from um and um I think that was the main and I was
going to bring up the the the the point that Jen Choy seeing all the IM programs at the bottom of the list when there's one IM program that sort of represented all of those based out of Knox County so that was confusing to me
too well that that's good feedback um I'll watch this video back just to make sure I'm hearing everything correctly and I'll collaborate with Doug um and so Dr ver perhaps you and I can talk about when would be appropriate to actually publish that yeah yeah yeah there may be a few a few little revisions but we get
it out there that's for sure so um yeah we can we can connect on that wonderful well thanks for the feedback and the discussion and uh I think you know with the news that the Appropriations for the next BM are the same you know we have
our our work cut out for us to keep doing the good work we can keep lobbying to increase that number but absolutely but it's nice to know that may be the lowest that we would it doesn't sound like we're at Brisco not being
there's continued support and but but how do we grow that support and get um really tell the story very you know and I think it was I think we've had some good opportunities lately I think we're going to get some invitations based on being at that
meeting that we were at um last week Lucas and I that you know people had an interest in this they talked people were asking questions like you know what about private funding and where are some other what are other opportunities what are other doing I mean there was just
some real uh Rich appetite to help solve this issue and yeah what are what are the other states doing and I know like Julie Reed from the isma reached out to us and we were looking at an article Cliff Dr Knight had found about Iowa and what they're doing and so we're going to
try to dig into a little bit more of what other states are learn from them and connect with them going to add one more to that mix I know Minnesota and Utah both have something that they were doing through medic and it's I really I'm not going to suggest that our Medicaid pay for it
it's something that RS through FAL govern actually very Tim actually uh Dr Hearn and I talked about this earlier this week um because I learned about this from talking to the founder of a u gme Consortium in New Mexico and when I
was telling him about our grant program here he said well how much you know are you getting matching federal funds and I said none that I'm aware of and so he explained that yeah through so this will be more to you guys than me and I'll start sound I'm say it like I know what I'm talking about so through
intergovernmental transfers and state program amendments spas that you can take um the money that the state appropriates you send it to the feds it goes through Medicaid comes back to Indiana to three times as much
as we send out but then the money comes from Medicaid to The Residency per rather than from UCB port and I yeah if that's working in other states it sure seems like I just learned about about a month month and a half ago and so I have tried to dig into it myself and I can't
find it yeah I tried to too after uh I talk about it yeah but I know that I think Utah is the one and I talked to the DI of University of Minnesota and they are getting as well so
yeah so it it it could change our lives so who at the state level would need to be willing to look at that whole process is it for billable business or is it just to come back to the residency I
think it's for gme and but I don't I that's why I don't have any of those details I ask only because of the Partnerships of the fqhcs with with the residency programs currently in our state that would be a thing to look at it feels a little bit like that what
yeah it does we get the enhanced medicate reimbursement right that helps offset the cost of the continuity clinic and I was even curious with that $45,000 loss that Dr Becker cited if that was the Assumption of the hospital running the continuity Clinic if you separate that
out um I'd be curious about that number that's still $45,000 for the hospital um or what it would be but yeah it's something to think about right and that's an on average the problem is one Hospital May get 130,000 a year per
resident another hospital 190,000 per year per resident and the most recent thing that I've seen published in academic medicine said it cost about 225 to 230,000 per year per resident so there's definitely a gap and the
45,000 um I think it was indicated was a sense of that be the average amount that a hospital spends on top of what they get from Medicare CMS so it's filling that Gap but that Gap obviously use to
expand and and the the numbers that I that sort of drove this home to me and I'm using I I should probably talk to Rob make sure he's okay with me sharing that they're getting about a million a year right now for their Psychiatry program you pull that million a year out how does a hospital like good St a small
Hospital in Von IND theana how do they make up that million dollars to to pay for their their Psychiatry residen so I mean this truly is is if we don't continue to increase the funding new programs that have started over the last few years are at risk of of going
away so um you know 45,000 a year doesn't sound like a whole lot but when you multiply it by the number of residents it gets pretty big over years yeah yeah do you have any thoughts on that Greg on who might be able to dig into that yeah I hearing that Dr D I
mean we're certainly happy to kind of take a first ad at at looking through if you could send that to Lucas anything that that you have available and dark Troy I mean that would certainly be uh above us uh you know as it relates to a decision but I think you know us kind of
taking a first stab and you know bullet points this is you know the purpose how it works how we could you know benefit from it um we would then share that with the CFO of the education virtual who is um Seth kinshaw um ultimately you know I
think that would be you know a convers that he would have to have with others were something that we um you know could and wanted to pursue yeah think be whoever you're whoever the state's expert on Medicaid financing of federal
matching funds that would be I to uh the Minnesota and I'll see if she can send me something yeah we're happy to to take a look and kind start there but that's yeah I happy to give just a little bit of like current Indiana context on those IGS and the match ing funds so the IGS
right now are what's used to fund hip um those Hospital assessment fees that are done through the TTS that get sent to the feds and they get matching funds and those come back multiplied right and that's how we fund hip 2.0 there's
legislation this session right now to um kind of modernize if you will the hospital assessment fee to leverage additional dollars from the federal level and redistribute kind more equitably distribute how those Hospital assessment fees are distributed across the entire State across kind of big and
small hospitals and hospital association's kind of carrying that and has been working kind of day and night I got ridiculous amount of kind of work put into this um that all goes through fssa ultimately met testified at the um
at the Committee hearing this week about kind of the work on it he was the architect of hi 1.0 and now they're going to they're kind of looking at this as maybe a 3.0 in some ways and so that kind of all eyes are on those IGS and how those federal dollars can get
leveraged at the moment for that piece so there's a fair amount yeah those intergovernmental transfers they got I'm sorry they got referenced earlier I apologize um so you know there's a lot of attention and a lot of discussion about it right now and I think once they get over the hump of
the hospital assessment fees are talking about implementing a new Medicaid um Managed Care assessment fee which is basically a tax on the Medicaid mcos Medicare organizations to help fund some of this work um then I think you know
there'll be a fair amount of recent experience with all of those things that have happened so that's the hospital Association the hospital Association is running point on that at the moment right so it sounds like they have some knowledge about these topics there there are a few of them that do it's
extraordinarily complicated and there's you in the space like midro you've been around for a long time but you know funding Ely this this too would impact hospitals because that's who funds most what about private investment too like
Lily foundations and other entities I know looks like Li is more around education religion that than heal but yeah do you want I I that up at the as a
business collaborative I I think it's you know it's well go ahead Julie yeah all I can say is um having attended the ibhc meeting and these guys did an excellent job and you've seen the presentation it was great it was great having them there and they did an excellent job the um Eli ly not the
foundation that Eli L does is a is a member of the idhc group along with us and a lot of others and um um they were in the room for the presentation and um are committed to waste figure out ways to kind of um support you know the
workforce I would strongly encourage not talking about that publicly because if the legislator's catch wind that somebody else could pay for it instead of them then that will be the answer and the discussions will be over um so I would strongly encourage kind of keeping
that under your RDS but um I do know there's interest out there if that comes with some possibility the other strong encouragement that I talked to L Messer about this just a couple days ago again about kind of an advocacy plan to support you guys sepher and frankly push so that if there does end up being a few
extra million bucks laying around come April we can push for like hey the GMU board actually doesn't need seven they actually need 14 and if you've got three or seven extra million dollars Ling around kind April like they actually need it the strong encouragement from L
mess was like hey Julie like continue to plant a seed that as those board members work on advocacy for their ask like the ask the need is 14 right it's not seven and really lay that track for that future growth even if it doesn't happen
this F yeah yeah so and 14 was what um SHP had projected us at no 14 I think it's our own internal projection of what we would need to fund the current programs that we're funding fully because remember we were at like what 11
million last year at that one just at that one meeting and so to to be able from 11 to 7 well what remember last when we did last year is we just funded the first couple years of the programs in order to get through this uh scenario
of not having adequate funds to support all of the programs so we actually need to double what we're currently getting to be on a sustainable full path to support the current programs fully otherwise we start to get to that point
where yes the older programs may fall off or whatever would fall based as a as a reminder the board received applications for 10.07 million in July that included one program development and one
feasibility um my recollection is 6.3 million 6.36 million was awarded um with those modified Grant terms of two years rather than still at the $45,000 per resident though yeah
so so we need D we need double break down this is really the story because in our sen years we had more to spend than we were being allocated because we have Surplus from previous years and so now we've been through all of the carryover
yeah from previous years and that's why it feels so cute right now I think is that yeah we don't have that we're never going to get Surplus I mean we'll never we need more we need that is the take we need more and a
lot more we need more seven is good because it's not a cut it's still it's gonna have to do something right so it's yeah but now I think we've got a clear story of like okay we need double right now to to even sustain and then to help
chip away at the the big gap that exists between us and these other neighboring states we've got we need like you know up to four times more potentially or whatever three four uh multiplier versus the two just to get through current state so um so I think that was you know
a simple message a clear message and backed by data and people were responsive so uh you know so we we have to in list Partners to help us with this message and that was I think part of that that work so yeah we're getting seven from the state then we're going to
have to get three and a half from Cade three half from private entities and then another another fnch more to even grow it oh there's other states that have a precedence of giving I mean allocating a lot more to this problem and particularly when you think of where
we fit in the scheme of the the frontier States and us you know then I think it's a compelling story where you know I'm sure IND legislators don't don't want to be that far behind having a physici work worse compared to other states so we just have to keep telling the story and
um and showing the return on investment showing these people stay in the state showing the data that we have and and I think you know I think there's possibility for for good traction um but it's going to take a lot of attention
and voices to be heard the more we can get out there and share that message the better but I think it's a good we're in a good spot in terms of getting I think we we caught convention there's no doubt about it may yeah um I know that a couple
upcoming presentations one from um the ibhc presentation we were approached um about giving a presentation sometime in August um the requestor is escaping me but that that's one um towards the end of the summer and then um in March the
rural gme has asked um myself and um someone from the boort to participate in a presentation as well um so those are two that kind of on the calendar right now I'm probably expecting a few more showing that's a national yeah all right well we are um I think
we've covered a lot of the content good discussion today any any last things from the board member and then I'll switch to public testimony okay um well uh yeah we have some guests here today from the public anyone want to share anything with the board who's uh in attendance today
Brooke I will um Brooke Mullen Department of Health uh to comment on Dr Knight about the work that the Bowen Center has been doing I'm actually Lucas has been very helpful in giving lots of numbers so we have completed a um medical education pipeline practice
study with the boen center that looks at Family Medicine Pediatrics and OBGYN Specialties I will have the draft on that by Tuesday of this week I'll be sharing it with our subcommittees and our Council and I'll send it to Lucas so that he can share with you guys as well so would love to have any feedback or comments you have on that hoping to
really get that ready for the legislator as well too so perfect thank you so much I I guess I'll just do a brief introduction I think I've pretty much met everybody but Dr I'm Rachel Reed I am the associate chief M officer atum
Regional um I yeah I am strange person was um Dr Tom conman is Rich GRE um at April 1 um well sort of moving into a transitional role and and fully retired at the end of the year and so he had put me forward as um to be ISB
representative on the board um at awaiting the appointment through the with the new Administration right so um just here visiting as a public member at the moment hopefully we'll be able to join appointed to join and I'm excited
I'm really enjoyed this conversation um like a little list of things I need to learn more about now about these grants and other things so this is just well just know that uh you're welcome as a public member today we hope that we get to officially
welcome you at a future meeting and there is a learning curve to being on this board so do not feel um uh that you have to master it all right away ask a lot of questions because honestly sometimes the newer our newer members ask questions that those of us who've
been around a while still even can scratch our heads and say why people ask question yes I've seen you on our emails and welcome and yeah we hope that that that process goes really uh you know get
it's accomplished before our next official meeting in early May uh okay fantastic any other uh any other folks Eric any other student advisory member I always want to give our students a chance to share any Reflections if they
would like to no no pressure yeah no I enjy the conversation it's it's exciting to see where the board's headed for this next year and the next following years um my only question I had was Lucas where's that uh flyer going to be published when it gets
done yep so that will be posted on the um graduate medical education board web page on the commission's website um I can send you the address and then I will also put it in the SharePoint site maybe a good thing to touch on um really so one of my goals here at the commission
is to try and Implement our GCC license a little bit bit more so part of that will be trying to um accomplish file sharing with the board members and advisory members through SharePoint um so I hope that everyone here has all the board members have access to that if you don't um please let me know I'll get
that that fixed um it'll also be kept there fantastic thank you all right any other comments all right well then other uh hearing none then I will U enter we will
see everyone at our next meeting May May 2nd on a Friday and uh I'll entertain a motion to adjourn our meeting today so all right all right and I presume everyone's in favor so we free to go stay warm and
we will see you all in uh in early Backes that's the one I know