Residency shortage leaves docs with no place to train

A residency shortage is leaving new physicians with no place to train, a commentary from the New England Journal of Medicine finds. With medical classes projected to reach 21,434 students by the 2016-2017 school year, nearly a 30 percent increase since 2002, the problem is insufficient residency posts to accommodate all the medical graduates.

Meanwhile, graduate medical education positions haven't grown much--only at an annual rate of 0.9 percent from 2001 to 2010. As the NEJM commentary explains, the "major stumbling block" has been the payment cap Congress put on Medicare's funding of advanced training in the Balanced Budget Act of 1997, Medicare being the primary support of GME programs. Looking to get about 15,000 more residency positions funded, the American Association of Medical Colleges (AAMC) and its allies lost their voice during debate over the Affordable Care Act.

But medical schools have done their part to reduce the shortage of primary care and specialty doctors, the commentary notes. "However, this will not result in a single new practicing physician unless Congress acts now to lift the cap on residency training positions," AAMC CEO Darrell Kirch was quoted as saying.

Florida and Texas are struggling the most in regard to lack of GME positions; in the past decade they've developed four new medical schools but have added very few GME posts, the commentary notes.

"Given enrollment growth, it may soon be impossible for all graduates of U.S. medical and osteopathic colleges to secure GME slots unless there is a sizable increase in the number of training positions," the commentary concludes. "The absence of health-workforce planning, a hallmark of the freewheeling U.S. market economy, may come back to haunt policymakers, particularly when physician shortages become more apparent as the ACA's coverage expansion takes hold."

As FiercePracticeManagement previously reported, 2013 marked the fourth straight year in which the residency-matching program placed increased numbers of medical school graduates into primary care training positions--due to increased competition in specialties and the Affordable Care Act's heavy emphasis on primary care.

In March, Reps. Allyson Schwartz (D-Pa.) and Aaron Shock (R-Ill.) reintroduced a bill to create 15,000 more residencies over the next five years--at a cost of $1 billion per year. 

To learn more:
- read the NEJM commentary

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