MERC: Eligibility of Small Training Sites
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During the 2003 session, the Legislature passed a change in the MERC statute (62J.692) that made small training sites (those that train less than 0.5 FTE students or residents from an accredited training program) ineligible to receive funds from the MERC and PMAP distributions. These programs distribute approximately $45-$50 million in funding to clinical medical, dental, pharmacy, physician assistant, advanced practice nursing and chiropractic sites every year. The proposed change would reinstate the small sites by eliminating the 0.5 FTE eligibility threshold.
Why this is an issue
As a result of the eligibility change, close to 100 rural facilities received reduced funding or no funding in FY2004, the first year that the cutoff was in effect. The change disproportionately impacted rural sites, which tend to be smaller and provide training to fewer students and residents than urban sites. Also strongly affected were the training sites used by specific programs, such as Minnesota’s only physician assistant program, pharmacy programs, and advanced practice nursing programs.
Overall, the change has resulted in a concentration of MERC funding at larger sites. Some sponsoring institutions and program representatives have argued that the change has made it harder to find small sites willing to host training, particularly in rural areas, and that the loss of these sites may have an impact not only on a community’s access to care but also on a student or resident’s opportunity to receive training in a variety of settings and on that student’s future likelihood to practice in a rural area.
A reversal of the eligibility cutoff for small training sites has widespread support among MERC stakeholders and the healthcare community. The MERC advisory committee, a group composed of medical education stakeholders representing multiple disciplines and areas of the state, opposed the change and petitioned the department in 2003 to reverse it.
In an analysis conducted for the MDH Office of Rural Health and Primary Care in late 2004 using data from the 2003 MERC distribution, MDH analysts found that 85 rural sites that received funding in FY2003 would have received less money or been eliminated entirely from the distribution had the small site cutoff been in effect at that time. The total estimated impact on rural sites would have been roughly $1.5 million, with an additional impact on small urban sites.
Between 2003 and 2004, when the cutoff went into effect, the number of training sites that received funding from MERC declined by roughly half. Much of this change was likely due to the establishment of the small site eligibility changes.
For more information
The MERC Web site contains an overview of the program and a legislative history describing changes that have been made to the MERC statute since 1998. The site also contains fact sheets showing the grants received by each training site in each distribution year.For more information, contact Diane Rydrych at 651-282-6349 or firstname.lastname@example.org.