New Bill Could Add 15,000 New Residency positions
The “Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act” was introduced on August 2, 2012 by Aaron Shock (R-IL) and Allyson Schwartz (D-PA). If enacted the bill would increase the number of residency spots in graduate medical education by 15,000.
Graduate Medical Education (GME), more commonly known as “medical residency”, was capped in the “Balanced Budget Act” of 1997 because a physician surplus was being predicted. The AMA has supported lifting the 1997 funding cap and advocates for an increase in GME positions to address a now foreseeable physician shortage. Throughout the last several years, new allopathic and osteopathic medical schools have been established and existing schools have increased their class sizes. Unfortunately the US continues to produce the same number of physicians, as residency positions have not mirrored this increase.
The funding for GME comes mainly from the Medicare budget, an estimated $9.5 billion annually. This amount is then split into two parts: $3 billion is for resident salaries called Direct Medical Education and $6.5 billion to subsidize the cost of running a training program, called Indirect Medical Education.
Every year there are 23,000 slots open to graduating medical students and overall there are 115,000 residency positions throughout the nation. Within these 23,000 slots, graduates from U.S. allopathic and osteopathic schools fill 16,000 positions and graduates of non-US schools fill the remaining 7,000 slots. It is for this reason that there are conflicting views on whether or not to raise the cap. The president of the American Medical Student Association stated that the cap shouldn’t be lifted, as 7,000 positions remain open to American graduates.
The main problem with increasing the number of residency spots is money, the AAMC estimates that between $12 billion and $15 billion dollars would be required to increase the number of GME positions by 15,000. The idea of cutting residency spots is more likely as the Medicare Payment Advisory Commission, who determines how Medicare funds are used, judged that 50% of GME funding is “empirically unjustified”. If 50% of GME funding were to be cut there would be a loss of 33,000 GME positions, a devastating blow to training physicians.
The new bill proposes to increase the number of residency slots by 3,000 each year between 2013-2017. At least half of the new slots must be used for medical specialties deemed to be facing a shortage. In order to determine which hospital would receive slots, the Center for Medicaid and Medicare Services would give priority to hospitals in states with new medical schools, hospitals that emphasize training in community health centers, and hospitals eligible for electronic health record incentive payments.
The Health and Human Services Secretary will have to establish measures of “patient care priorities” in Graduate Medical Education. If a hospital were to not meet the patient care measures it will have its Indirect Medical Education payments reduced by 2%. The Secretary must also issue an annual report on Graduate Medical Education payments made to the hospitals and factors contributing to higher patient care costs at each hospital.
The likelihood that this new bill is enacted is slim considering only 4% of proposed bills are enacted in a given year. Nevertheless, the expansion of health insurance coverage will increase the demand for physicians and this issue will need to be addressed in the near future.
Region 6 Policy Chair