Shortage of residency slots may have chilling effect on next generation of physicians

Most people are aware of America's looming physician shortage, but the shortage of residency slots for medical school graduates has received less attention.

In order to practice medicine in this country, graduates of allopathic (MD) and osteopathic (DO) medical schools must complete a residency training program. In recent years the number of MD and DO graduates has increased by more than 23 percent in an effort by schools to address the country's growing physician shortage, which the American Association of Medical Colleges estimates will approach 90,000 too few physicians by 2025.

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While the number of medical school graduates is increasing, the number of residency training positions has not kept pace. If this imbalance is not addressed, the number of American MD and DO graduates will exceed the number of first-year residency positions, which by some estimates could occur as soon as 2017. When this happens, young physicians-who dedicated years to the pursuit of a medical education and incurred significant debt doing so-will not be able to practice medicine, and the physician shortage will persist.

Part of the problem stems from the funding mechanism for Graduate Medical Education (GME). Medicare covers the majority of the cost teaching hospitals spend on training medical residents, but the Balanced Budget Act of 1997 capped the number of residency slots the federal government would fund. The shortfall-what is not covered by the Federal government-is paid for by the hospitals where residents train. While it is possible to increase the number of residents they train, to do so, hospitals must fund the entire cost of those training positions.

Though patient care has shifted its emphasis to wellness and prevention, the current reimbursement system has not yet caught up. It is still based on the number of procedures performed, incentivizing hospitals to fund additional residencies in revenue-producing specialties instead of primary care.

Adding to the problem, are for-profit schools that pay hospitals for medical student residency training spots-an incentive for some cash-strapped hospitals-something that is a growing concern among medical school deans. Residency slots that are taken by trainees from non-accredited schools reduce the number of slots available to trainees from accredited allopathic and osteopathic schools.

Some of these non-accredited for-profit schools train as many as 1000 students a year without clinical facilities or full time faculty. According to a 2013 Bloomberg Markets investigation, many students who attend these schools incur tremendous debt and fail to complete the programs; many of those who complete the programs are unable to find a residency.

The shortage of residency slots is also affecting graduates of accredited programs. Last year, more than 500 graduates from US allopathic medical schools were unable to obtain a residency training position. As more students graduate from medical school in the coming years, this number will only increase.

We need to find ways to address the shortfall. There are several solutions being considered.

The Foreign Medical School Accountability Fairness Act, a bi-partisan bill from the House and the Senate that would protect taxpayers and students, eliminates an exemption that entitles certain foreign medical schools to US Department of Education Title IV funding without meeting minimum requirements. The bill would ensure that 60 percent of enrollees in medical schools outside the US and Canada must be non-US citizens or permanent residents and have at least a 75 percent pass rate on the US Medical Licensing Exam.

Other pending legislation includes the Training Tomorrow's Doctors Today Act, which would add 15,000 new residency training positions over the next five years; and the Resident Physicians Shortage Reduction Act of 2015, which aims to protect against the rapid shortfall of primary care physicians.

The Affordable Care Act's $230 million Teaching Health Center Graduate Medical Education Program is designed to train primary care physicians mostly in non-hospital settings, which is exactly where the majority of primary medicine is practiced. Moreover, many of these new training programs serve underserved communities. These residency programs do not rely on Medicare funding, but must be self-supporting by 2017.

These efforts all have merit, but the wheels are turning slowly and the clock is ticking.  Training physicians doesn't happen overnight. Our lawmakers need to move quickly for the sake of patients and the physicians who have invested so much time and effort into learning how to care for them.

Koeppen is founding dean of the Frank H. Netter School of Medicine at Quinnipiac University.

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