Perhaps this has happened to you (and if it hasn't, it might happen soon). You need to see a Doctor, but you’re told you can’t see the Doctor for weeks or maybe even a month. Or maybe your trusted family Doctor has either moved away, died or retired, and an all-purpose medical group has moved into that office. More than likely you’ll have to get used to seeing non-Doctors including nurses and APNs for routine office visits.
Unless the projected Physician shortage is reversed, that’s the future of medical care. If that doesn’t sound wrong, how would you feel if you were on trial in a case where your life, liberty or livelihood was on the line, and the only person you could find to argue on your behalf was a paralegal, not a licensed attorney? Unlike an attorney, every time you see a Doctor there’s a chance that his or her skills will discover and treat something that would otherwise severely impact your health.
According to the Association of American Medical Colleges, by 2032 there will be a shortage of up to 120,000 Physicians including primary care, specialists and surgical specialists. What’s worse is that the population over 65 is expected to grow by 8% also by 2032, putting a greater strain on medical services. And Doctors are getting older, too. In the next decade two in five Physicians will be over 65 and looking to cut their hours or retire.
Why Can’t We Just Train More Doctors?
One common misconception is that the reason we don’t have enough medical students in the pipeline to meet any shortage is that we lack gifted applicants that want to dedicate their lives to Medicine. On the contrary, AAMC statistics reveal that applications to Medical schools have risen by 25% over a 10 year period with 10,000 more applicants to U.S. medical schools in 2018 than there had been 10 years earlier. And they more than qualified for admission. According to CNBC.com’s Jack Novak, “Medical school applicants need to have near-perfect GPAs and very high MCAT (Medical College Admission Test) to get accepted to an accredited U.S. institution.” But that’s not enough. Novak continues, “Even among that much better qualified pool of applicants, only about 50 percent get accepted. Imagine if only half of our high school graduates who applied for college got into any college – there would be riots at admissions offices every spring.”
According to U.S. News & World Report’s “Why it’s Hard to Get into Medical Schools,” by Ilana Kowarski, the 50% acceptance rate doesn’t take into account that some of the highest ranked schools accept less than 4% of their applicants. In light of a Physician shortage that is racing toward us like a runaway train, it seems outrageous that schools aren’t accepting more applicants. Well, it’s complicated.
We’re all familiar with the term “infrastructure.” We tend to think of it as a term that describes roads, tunnels and bridges. But there is something called health care infrastructure. Just as roads and bridges infrastructure crumble when they aren’t upgraded and maintained, so does our health care system infrastructure. Citing Dr. Richard Olds, the president of St. George’s University in the Caribbean and previously the founding dean of the University of California—Riverside School of Medicine, Kowarski notes, “few medical schools opened between the late 1970s and early 2000s, and very little expansion of medical schools occurred during that period thanks to an inaccurate but widely publicized labor market forecast projecting a surplus of doctors. Meanwhile, the need for doctors in the U.S. was rapidly rising, and medical schools were not meeting that need.” To be fair, medical schools have increased enrollment by 30% since 2002, but it is not enough. Even if it was, more devastating underlying cause of the Physician shortage can be traced to what happens to these medical students once they receive their degrees.
To become a practicing Doctor in the U.S., medical school graduates must complete a residency program. However, for the past two decades, constraining the number of residents funded by Medicare—which is the primary source of payment for residents—has limited the expansion of training programs and the number of trainees.
And What About The Law?
In 1997, the Balanced Budget Act created an arbitrary cap on the number of Medicare-funded graduate medical education (GME) positions. It remains in place, limiting the number of medical residents that are counted for purposes of calculating direct graduate medical education (DGME) and indirect medical education (IME) payments to the number of trainees as of 1996. This limitation effectively prohibits existing teaching hospitals from receiving Medicare-support for any new medical residency positions added after 1996. As medical school enrollment continues to grow, the Medicare GME cap has made it difficult for medical resident training to keep pace, resulting in a severe bottleneck in Physician training.
To deal with this issue, two bills in Congress would fund more residencies that would produce more licensed Physicians.
In the House of Representatives, Reps. Terri Sewell (D-AL) and John Katko (R-NY) introduced The Resident Physician Shortage Act (H.R. 1763) that would support an additional 3,000 positions each year for the next five years, for a total of 15,000 residency positions. It would increase the number of Medicare-supported direct graduate medical education (DGME) and indirect medical education (IME) medical resident training positions. On the Senate side, Senators Bob Menendez (D-N.J.), John Boozman (R-Ark.) and Chuck Schumer (D-N.Y.) introduced the Physician Shortage Reduction Act of 2019 to increase Medicare-supported Doctor training slots also by 15,000. The Senators’ bill would prioritize increasing positions in states with new medical schools, hospitals training Physicians in excess of their cap, hospitals who partner with VA medical centers, as well as hospitals who focus on community-based training settings.
As promising as this legislation is, time is running out for taking action. It takes seven to 15 years for Physicians to complete their training, so the time to act is now. 3
