As a neurosurgeon whose career has focused on academic research and training the next generation of doctors, I am convinced that the time has come to expand Medicare’s support for residency training to ensure all Americans have access to the care they deserve now and into the future.
Currently, the country faces a severe physician workforce shortage — one that will only worsen as more Americans obtain health insurance and baby boomers continue to reach retirement age.
By the year 2032, the United States will see a shortage of up to nearly 122,000 physicians — a shortfall of roughly 25,000 to 66,000 specialists and 21,000 to 55,000 primary care physicians, according to a 2019 study conducted by the Association of American Medical Colleges (AAMC).
The current shortfall in number of needed physicians is already having consequences that jeopardize timely patient access to specialty care. Consider the following:
1. Demand for services is increasing: Particularly in the specialty fields of cardiology, urology, dermatology, endocrinology, ophthalmology, gastroenterology and neurosurgery. This outpaces demand for adult primary care services. As a result, patients are experiencing considerable wait times for care.
2. The maldistribution rate among physicians, especially in rural communities, is significant, and in many parts of the country, Americans have limited access to specialty health care.
3. Physicians are getting older. In fact, one-third of all currently active doctors will be older than 65 in the next decade. Depending on the specialty, it can take up to 18 years — including college, medical school, residency and fellowship — to train a specialty physician, and once gone from the workforce, they are not easily replaced.
The magnitude of the projected physician workforce shortage speaks to the need to expand the number of residency training slots. Although the number of medical students being trained in the U.S. is increasing due to the opening of new medical schools and the expanding class size of existing schools, no corresponding increase in the number of Medicare-funded residency training slots has occurred.
This is because more than two decades ago the Balanced Budget Act of 1997 capped graduate medical education (GME) funding. This cap is highly problematic because it is not the number of medical students trained, but rather the number of positions in the GME system that determines the supply of physicians. Because of the growing need to increase the size of the physician workforce and the time it takes for a resident to finish training, it is essential that Congress approaches this problem with the sense of urgency it deserves.
To address the growing physician workforce shortage and ensure a physician workforce that is of sufficient size and specialty mix, the Alliance of Specialty Medicine is calling on Congress to pass legislation to eliminate the current GME funding restrictions. To further this objective, the Alliance has endorsed the Resident Physician Shortage Reduction Act (S. 348/H.R. 1763). Sponsored in the Senate by Sens. Robert Menendez (D-N.J.), John Boozman (R-Ark.) and Charles Schumer (D-N.Y.), and in the House by Reps. Terri Sewell (D-Ala.), John Katko (R-N.Y.), Xochitl Torres Small (D-NM) and Rodney Davis (R-Ill.), these bills would increase the number of Medicare-supported residency slots by 15,000 over five years. If adopted, this bipartisan legislation would go a long way towards addressing this looming physician workforce crisis.
An appropriate supply of well‐educated and trained physicians is essential to ensure timely access to quality health care services for all Americans. America’s specialty physicians challenge Congress to meet these needs by adopting legislation to increase the number of Medicare-supported residency positions.
Alex B. Valadka, M.D. is the chairman of the Department of Neurosurgery at Virginia Commonwealth University School of Medicine and serves as the spokesperson for the Alliance of Specialty Medicine, a coalition of national medical societies representing more than 100,000 specialty physicians in the United States.