Physician Shortage: Support the Resident Physician Shortage Act

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. 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.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

REFERENCES:

  1. https://www.modernhealthcare.com/providers/cost-graduate-medical-education-stifling-ability-bolster-physician-workforce
  2. https://members.aamc.org/eweb/upload/Medicare%20Payments%20for%20Graduate%20Medical%20Education%202013.pdf
  3. https://www.thedoctorshortage.com/pages/shortage/?utm_medium=email&utm_source=aamc&utm_content=3&utm_campaign=2019ws2&source=2019ws2
  4. https://mk0nrmpcikgb8jxyd19h.kinstacdn.com/wp-content/uploads/2019/04/NRMP-Results-and-Data-2019_04112019_final.pdf

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Robert Duprey MD

Robert P. Duprey Jr studied medicine as a 2nd career medical student who went to medical school in his 40’s after honorable discharge and ‘retirement’ from 25 years in the US Military (USCG & US Army). He was a registered nurse (RN) with specialty training as a psychiatric RN in the US Army for 15 years. During this time he also became a Master’s level psychotherapist in 2002. While on US Army active duty he also became a Psychiatric Nurse Practitioner while working full time in 2011. He served as a Psych NP on active duty, to include a combat tour in Iraq, until his ‘retirement’ in 2014 and moved to Philippines with his 3 children. At this time he started medical school overseas at Oceania University of Medicine based out of Samoa accredited by Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU). He continued to work as a Psych NP throughout medical school to support his children and to not have to take out loans for medical school tuition. Originally from Rhode Island, he completed medical school clerkship rotations throughout the USA with a graduation in May 2019 earning the esteemed credential of MD. He has successfully completed USMLE Steps 1, 2CS, and 2CK. He will take Step 3 this September as he applies for Psychiatry Residency. Having been and RN, NP and now MD, he is a believer of Physician led multidisciplinary healthcare teams 

  1 comment for “Physician Shortage: Support the Resident Physician Shortage Act

  1. Pat
    May 22, 2019 at 4:28 pm

    Perhaps fat hospital corporations could offer residency positions to those unmatched, in exchange for a specified post-residency period of indenture? Which would suck.

    Any yet here is medicine again, with its beggin’ bowl out, pleading with Congress to fix something it shouldn’t have been involved in to begin with. But now all of health care is so permanently dependent on government cash that it seems the only answer. And this very government that is desperate to save Medicare dollars will be oh so tempted to consider cheaper NP options that they will probably fund some sort of ARNP residencies.

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