Op-ed: The U.S. must fund more medical residencies
As the country rapidly ages even as it faces a doctor shortage, one effective means to improve access to care is to immediately fix a 20-year-old problem.
Written by Craig Colgan
Client: President of medical education organization
In a major study out last month, the federal government admitted it needs to do a better job of understanding how to fix a serious healthcare problem, that health educators have known about since 1997. That was the year Congress imposed a cap on Medicare support for graduate medical education. Congress can take a big step forward to addressing major physician workforce challenges looming in this country by passing the Residency Physician Shortage Act of 2018, which provides needed funding for medical residencies. But it is just a start.
A tsunami of unstoppable demographic challenges is bearing down. The United States needs more physicians. A 2017 study by the Association of American Medical Colleges reports that the country faces a shortage of up to 100,000 physicians by 2030, when adding both primary and specialty care. The data show that if members of underserved populations accessed healthcare at the same rate as wealthier Americans, that need for more physicians would be immediate. So as more Americans advance into the middle class, they will seek more care. And about one-third of doctors will likely retire in the next decade. These and other factors will boost demand.
Another factor is that the country is aging. By 2040, the number of people in this country age 65 and older will have increased by 76 percent. Which means of course more Americans will simply need more care. Patients younger than 65 average about half as many annual medical visits as those older than 65.
And too many people in this country live in areas where their health is at risk. As of January, more than 82 million people across the U.S. live in areas designated by the government as Health Professional Shortage Areas. Important programs such as National Health Service Corps provide financial assistance to healthcare professionals willing to serve in these areas of need. But for many graduates seeking to take the final step in their education, very real roadblocks await.
In 1997, Congress capped Medicare funding for graduate medical education. The Resident Physician Shortage Reduction Act of 2018 would fund 15,000 residency positions over five years, beginning in 2019. The bill requires that at least 50 percent of the residencies be provided to graduates serving in specialty areas experiencing shortages. Though this is a modest increase and first step, this bill deserves immediate action. For 20 years, teaching hospitals have found ways to cross-subsidize residency positions, but continued threats to Medicare make this more difficult.
There is good news. Enrollment in medical schools has increased by nearly 30 percent over the last 15 years, and 22 new medical schools have been established. But funding for residencies has simply not kept up. The Government Accounting Office reported in March that the federal government does not do a good enough job collecting data on the effectiveness of its investment in graduate medical education. This has to change.
Finally, there is the argument that the best way to look at this problem is not as a surging shortage of physicians in absolute terms, but that we simply have too many healthcare professionals practicing in some specialties, and not enough in others, and especially not enough in primary care areas. The fancy term for this is “maldistribution.” It turns out that one solution addresses all this, regardless of how we frame it.
International medical graduates comprise more than half of those who care for elderly patients, and are more likely to practice in areas of the country where there is the greatest need.
We know that international medical graduates provide quality care every bit as good as domestically trained doctors. But burdensome licensure rules can interrupt lives and slow careers, because in many instances these graduates must repeat in the U.S. already completed residencies. Just about half of international medical graduates are accepted to residencies here in the U.S., compared to 90 percent of U.S.-trained doctors. There are several reasons for this. The most direct path forward here, in addition to Congress acting, is for licensing bodies and teaching hospitals to work together, to find innovative solutions and remove these needless impediments.
Let’s repair this process and fund more residencies for all those who seek to fill crucial physician needs here in the U.S. We cannot wait any longer.
©2018 Craig Colgan • ColganWrites.com