Thawing the Landscape of the Era of High Throughput: Signs of Spring?

: In his latest book, Dr. Kenneth Ludmerer examines the history of graduate medical education (GME) in the United States, including its "era of high throughput" during which residents admitted more patients for shorter periods of time as hospitals focused on decreasing length of stay secondary to prospective payment reform. The author of this Commentary considers the implications of the era of high throughput and how the U.S. health care system must change to address its lasting effects.The era of high throughput initially had incomplete penetrance across the health care system landscape and a variable effect on GME. Trainees were variably aware of the financial forces bearing down on the health care system. Over time, the pervasiveness of the financial pressures and managed care became more complete, and the ubiquity of information through the Internet and social media ensured that residents became more acutely aware of how the changes to the health care system were affecting their education. There is now an opportunity for GME to be the nidus for ushering in an era of cost consciousness focused on patient needs and higher-quality GME rather than on the financial pressures that characterized the era of high throughput.