Infrastructure bill includes record increase of 4,000 Medicare-supported GME slots to combat looming shortage

The latest version of a massive $1.75 trillion infrastructure and social spending package aims to include a record 4,000 additional Medicare-supported graduate medical education (GME) slots in a bid to head off a looming physician shortage.

The legislative text, released by the House late last week and to be considered in the coming weeks, also includes a new program to increase physician diversity in training. Advocates are pressing Congress to ensure the legislation stays, as the package could face further changes.

“We think it is important the provision survives. I don’t see any reason why it wouldn’t, but it still has to get through the House and go over to the Senate,” said Leonard Marquez, senior director of government relations and legislative advocacy for the Association of American Medical Colleges (AAMC), in an interview with Fierce Healthcare.

The latest report from the AAMC finds there could be a physician shortage ranging between 37,000 and 124,000 by 2034, with all specialties, including primary care, being hit.

“The primary driver of those projections is the demographics of the U.S. population and the aging baby boomer population that will require additional healthcare services,” said Matthew Shick, senior director of government relations and regulatory affairs for AAMC.

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If the provision is included in the final law, it will build on an investment in a spending package passed by Congress last year that increased the number of Medicare-supported GME slots by 1,000. The package included new criteria on where those physicians would be allocated and which teaching hospitals would receive them.

Medicare agrees to defer some of the cost for training for a certain number of physicians at each eligible hospital. The increase in the spending bill was the first in nearly 25 years, Marquez said.

The proposed increase of 4,000 slots of Medicare-supported GME includes similar criteria for allocations to certain hospitals. For example, 25% of the physicians must go into primary care and another 15% into mental or behavioral health specialties.

There are also 20% of slots that must go to hospitals in rural areas along with a certain number of slots to teaching hospitals in underserved areas.

“We thought the [Continuing Appropriations Act] was a great first step and [we are] happy to see them building on that,” Marquez said of Congress.

In addition to more support for GME, the legislation includes expanding Medicare coverage for hearing, extending enhanced subsidies for Affordable Care Act coverage and closing the Medicaid coverage gap.