Is the U.S. training enough doctors? Data aren't adequate to answer, GAO study says

The government needs better information to know whether the country is training enough future doctors to meet patient needs, according to a Government Accountability Office report.

In a new report, the GAO recommended that the Department of Health and Human Services get a better handle on those data to help ensure government funds that go toward paying for residency training are being used effectively.

Otherwise, no one can know for sure whether there will be enough doctors trained in the specialties patients need in the places people need them, the report said.

Studies have identified shortages of certain types of physicians, with rural areas in particular already battling to keep and recruit enough doctors. Residency training is one of the factors that impacts the supply and distribution of physicians, the GAO said. Studies have shown there will be more than a shortage of primary care doctors, with a need for specialists to care for aging Americans.

The Association of American Medical Colleges (AAMC) in 2017 projected a shortage of up to 104,900 physicians in the U.S. by 2030. While that projection included a shortage of up to 43,100 primary care physicians, the AAMC projected an even larger deficit of up to 61,800 specialist physicians.

“Multiple federal programs fund graduate medical education for physicians-in-training, known as residents. However, the government doesn't know if these dollars are helping to build the physician workforce that the nation needs,” the GAO said in the report (PDF). Data collected don’t provide all the information to understand how much it costs to train physicians, how much the government spends and what the government is getting for its money, the report concluded.

Overall, federal agencies and state Medicaid agencies spent more than $16.3 billion in 2015 to fund graduate medical education (GME) for doctors. The federal government spent $14.5 billion through five programs, and in addition, 45 state Medicaid agencies spent $1.8 billion, the GAO said. About half of teaching sites that received funding, including teaching hospitals, received funds from more than one of those five programs.

But it gets complicated, as training costs vary depending on the characteristics of teaching sites, such as the number of residents they train and their specialties. That makes it difficult to compare training costs across sites. And some costs, such as faculty teaching, are difficult to identify, the report said. With no standard method to identify and capture costs, sites may vary in how they collect the information.

It’s not the first time the GAO has visited the issue. Two years ago, in 2015, the GAO recommended HHS develop a plan to identify and address healthcare workforce needs. While HHS concurred, it has yet to take the steps it identified and information currently available is insufficient for such planning, the GAO said.

In the new report, it again recommended the HHS secretary coordinate with federal agencies that fund training, including the Department of Veterans Affairs, to identify information needed to evaluate federal GME programs and identity opportunities to improve the quality and consistency of information.

HHS agreed with the GAO, and in its response noted that President Donald Trump’s fiscal year 2019 budget for HHS proposes consolidating federal spending on GME programs into a single grant program for teaching hospitals. It would allow HHS to modify payment amounts based on criteria, including addressing healthcare workforce shortages.