Physicians agreed at the 2014 AMA Annual Meeting: More graduate medical education (GME) positions are necessary to ensure there are enough doctors to meet the nation’s health care needs. Delegates passed policy to investigate new solutions for GME funding and workforce expansion and to continue advocating for additional federal GME funding.
The AMA Council on Medical Education detailed the physician workforce’s current state in a report, noting that expanded insurance coverage resulting from the Affordable Care Act (ACA) will mean the demand for primary care physicians will grow by an estimated 14 percent by 2025. More insured patients, combined with an aging population and retiring physicians, contribute to increased demand.
To help meet this need, medical schools have increased their class sizes, and several new schools have opened. But a proportional increase of GME positions has yet to happen, chiefly because the Balanced Budget Act of 1997 has left the number of GME positions funded by Medicare capped at 1996 levels. The report noted that GME institutions have added positions, but mostly in subspecialty areas, as hospitals are limited in their ability to increase support for entry-level positions available to medical school graduates without prior GME.
Federal support for GME expansion is mostly unlikely, the report said. There are a few provisions in the ACA to expand GME, but these are limited through next year, making only a small impact on a much larger problem.
States do have options to alleviate the problem, either via alternative GME funding or by encouraging physicians to practice in the state in which they complete their training. For example, a Minnesota program offers a $1 million grant for family medicine residency programs outside the state’s metropolitan area. Programs must demonstrate that at least a quarter of graduates practice in rural Minnesota communities for the most recent three years.
Likewise, as part of a public/private partnership, Iowa-trained physicians may commit to serve for five years in one of the state’s communities that has fewer than 26,000 residents and is more than 20 miles from a large city. In exchange, these physicians can receive up to $50,000 a year for four years to pay medical school loans.
Physician-led team-based care may be a promising way to improve patient access to health care, potentially allowing more patients to be seen and improving efficiency. Other innovations in health care delivery reform, including accountable care organizations, may have a similar effect. However, no data exist yet to support these conjectures.
Under new policy, the AMA will continue to address this crucial issue by:
- Continuing to advocate that Congress fund additional GME positions, such as via the AMA’s SaveGME campaign
- Advocating for accredited residency programs in rural and other underserved locations, particularly in the offices of physicians who meet the qualifications for adjunct faculty of the residency program’s sponsoring institution
- Encouraging the Accreditation Council for Graduate Medical Education (ACGME) to reduce barriers to rural and other underserved community experiences for GME programs
- Urging the ACGME and the American Osteopathic Association to continue developing and disseminating innovative ways to train physicians, with emphasis on physician-led, team-based care
- Working with interested state medical associations and national medical specialty societies to share and support legislation to increase GME funding
- Supporting ongoing state efforts to identify and address changing workforce needs and continuing to advocate for innovative pilot programs
- Continuing to work with stakeholders to analyze the changing workforce landscape and the number and variety of GME positions necessary to provide that workforce
