I’ve said it before and I’ll say it again, the physician shortage is a physician problem to solve; but it literally will take an act of Congress to change. Bottom line up front (BLUF): the key to physician shortage is increasing the cap on residency slots and Medicare funding for such positions. This article references that “GME positions are not keeping pace.”Simple solution would seem to simply add more residency positions. This of course lies in the hands of government funding and money issues. With the cost of health care in the US, it seems difficult to find and use more money to add GME positions. The article state “With limits to how many GME slots Medicare will cover, hospitals and themselves taking on a growing percentage of the burden.”1For example:
“In 2018, total expenditures for GME cost UMass Memorial more than $215 million to train 525 residents, according to figures provided by the system. Medicare reimbursed more than $84 million of those costs, leaving a budget shortfall of $130 million.”1
This puts hospitals on the spot to cover additional costs for the Medicare shortfall. This shortfall is due to that in 1997 congress passed a law (Balance Budget Act) that imposes a hospital-specific limit on the number of residents that Medicare will pay for. In general, the limit (often referred to as the hospital’s resident “cap”) is based on the number of residents that a hospital trained in 1996.2As such, costs that hospitals incur for trainingphysicians are reimbursed by the federalgovernment through Medicare, which made up71% of GME government funding.
The physician shortage is well known.3 In fact, in the 2019 Match, there were 38,376 active applicants for the 32,194 first-year and 2,991 second-year (including physician (R)) residency positions.4 Well, do the math on the number of unmatched applicants due to position limitations.
Teaching hospitals have in recent years taken it upon themselves to create more residency positions at their own expense. However, “There is coming a point in which hospitals just cannot incur the costs anymore without needing additional external support from the Medicare program.”The good news: In February, a bipartisan group of senators introduced the Resident Physician Shortage Act, which aims to add up to 15,000 new residency positions over five years by allowing for increased payments for direct GME costs, which would train an estimated 3,000 new physicians. While I believe this doesn’t go far enough, at least it’s a start. This is also where current physicians and physician groups come in and take responsibility to promote support for the Resident Physician Shortage Act – lobby and write to Congress: https://www.thedoctorshortage.com/pages/shortage/?utm_medium=email&utm_source=aamc&utm_content=2+-+Learn+more+and+say+youll+get+involved+in&utm_campaign=2019ws2&source=2019ws2