Solution exists for doctor shortage

As referenced in the July 9 Congress Blog post “Discrimination against foreign medical schools is bad for your health,” the Association of American Medical Colleges (AAMC) projects a nationwide shortage of between 46,000 and 90,000 physicians by 2025. However, the author, Robert Goldberg, grossly mischaracterizes the capacity of the nation’s medical schools to adequately train the number of physicians needed to meet the shortfall. 

In 2006, the AAMC called on medical schools to increase enrollment by 30 percent, and they are on track to meet that goal by 2018. Existing schools have increased enrollment and 19 new medical schools have opened their doors. In addition, enrollment in U.S. osteopathic medical schools has increased. Combined first-year enrollment at existing medical schools is projected to increase 45 percent overall. Students who enrolled in the nation’s medical schools this year reached a record high. At the same time, graduates of international medical schools will continue to play an important role in the U.S. physician workforce, representing about a quarter of practicing physicians. 

{mosads}The AAMC supports a balanced physician immigration policy that prevents “brain drain,” and its workforce recommendations assume a continued significant presence of international medical graduates (IMGs) entering the U.S. system. However, both U.S. graduates and IMGs face a common problem: enrollment growth is outpacing the number of available U.S. medical residency positions, training every physician must complete to practice independently. U.S. residency training programs are significantly stifled by a cap on Medicare graduate medical education (GME) funding set by Congress in 1997. 

The “real legislation that will increase opportunities for physicians,” as Goldberg put it, do exist: the Residency Physician Shortage Reduction Act of 2015 (H.R. 2124 and S. 1148). If passed by Congress, the bills would increase Medicare GME slots by 15,000 over five years. It can take up to 11 years to train a physician. The time to act is now.

From Atul Grover, chief public policy officer, Association of American Medical Colleges, Washington, D.C.

The Hill’s July 14 “Bottom Line” misrepresents the position of the National Industrial Sand Association (NISA) on the Occupational Safety and Health Administration’s proposed rule regarding crystalline silica.

OSHA’s proposed rule is modeled in large part on the occupational health program developed by NISA companies almost 40 years ago, which has resulted in the eradication of silicosis from sand company workplaces.

OSHA officials as well as representatives of the AFL-CIO and the public health community have praised the sand companies for the occupational health program’s worker protection provisions, which include dust controls, dust monitoring and medical surveillance of employees.

Silicosis is a completely preventable occupational disease and NISA strongly supports a new silica rule that will require other industries to protect their workers the way the sand industry does now.

Because the sand companies have eradicated silicosis in their work places under the current permissible exposure limit, NISA does not believe that worker protection requires OSHA to reduce the limit by 50 percent, as it also has proposed. That step would increase the cost of controls four-fold.

We strongly support the exposure monitoring and medical surveillance provisions of OSHA’s proposed rule because they are sufficient to protect workers. We do not support unnecessarily reducing the permissible exposure limit.

From Mark Ellis, president, National Industrial Sand Association, Washington, D.C.