As the U.S population continues to grow and the number of elderly citizens surges, the demand for physicians is at an all-time high. In the next decade, the number of Medicare beneficiaries is expected to rise by 49% and, by the same time, nearly a quarter of today’s doctors are expected to retire. Research predicts that by 2025 the United States will face a shortage of between 46,000-90,000 physicians who are critical to national health and well-being. According to statistics from the federal Health Resources and Services Administration, nonprimary care specialties are expected to see a shortage of about 62,400 doctors. Another AAMC study estimates that by 2025 growing demand for primary care physicians will exceed supply by nearly 45,000 needed physicians. This is going to affect all patients – but patients needing specialty care and those living in poor, rural areas will be the most affected. To ensure the health of the future, it is important that these issues are addressed immediately while there is still time to train future doctors and physicians.
The Association of American Medical Colleges (AAMC) has proposed a comprehensive multi-pronged approach to address the issue by optimizing graduate medical education (GME). Their proposal depends on increased government funding for GME.
The recent history of government funds for residencies
The Clinton Administration’s 1997 Balanced Budget Act imposed stringent “caps” on the number of residency positions available to GME teaching hospitals, essentially “freezing” the status of residency education despite the growing need for patient care. These restrictions limit the number of residency positions available. The limitations on residencies lead to limitations on the number of physicians who emerge every year, ready to treat patients. And this is the problem - not enough new doctors to meet demand.
Investing in future physicians: Funding residencies
According to the AAMC, investing in graduate medical education (GME), will help ensure hospitals are well funded, staffed and can continue providing patients with the most advanced care. By limiting the number of residency slots available to teaching hospitals, the Balanced Budget Refinement Act ended up restricting overall GME funding. The current agenda proposed by the AAMC is the Resident Physician Shortage Reduction Act of 2015. It seeks to stimulate GME funding by increasing the number of residency slots nationally by 3,000 each year between 2017-2021. If passed, the increase can:
Offset a portion of the direct costs that teaching hospitals currently face for training residents.
Allow teaching hospitals to maintain state-of-the-art facilities and equipment (such as Level 1 trauma centers), and specialized services (e.g., advanced cancer care) that are critical for the environment in which health professionals must be trained and the health of the community.
Allow teaching hospitals to train a greater number of residents, leading to an increase in future doctors
While current legislative plans for GME funding reform haven’t yet been realized, proposed solutions include increasing residency slots in teaching hospitals, consolidating funding streams based on the combined direct and indirect expenses associated with training programs, and allowing individual states to handle their own GME budget and program oversight. By restructuring the system that allocates GME funding, there is hope for growth in training centers across the U.S.
If nothing is done to more aggressively address the physician shortage, poor health-care outcomes are inevitable. In addition to the serious shortage of primary care physicians, the U.S will also face a shortage of over 21,000 surgeons by 2020. This means that some essential operations will be placed on hold. Rural communities will bear the brunt of this issue as doctors flock to heavily populated areas to find the most profitable work. Currently, the bulk of the proposed solution lies in the hands of our legislators and groups like the AAMC and AMA lobbying for said federal support.
What do you think? Is your school concerned about placement opportunities for your students? What are you (or they) doing to investigate or address these concerns?