Medicare-funded residency positions could increase by 15,000 over the next five years if a newly introduced bill is adopted. The legislation underscores the importance of increasing graduate medical education (GME) funding amid a predicted shortage of 46,000 to 90,000 physicians by 2025.
The Resident Physician Shortage Reduction Act of 2015 is part of a multi-pronged approach to increase the number of residency spots available to students as medical schools have increased enrollment by 30 percent over the last several years. 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 act, which was introduced to the U.S. House of Representatives by Rep. Joseph Crowley, D-N.Y., and to the U.S. Senate by Sen. Jon Tester, D-Mont., outlines important provisions about the new residency slots and funding.
- The number of new residency spots would gradually increase each year—not all at once. Residency positions will increase nationally by 3,000 each year from 2015 to 2019, resulting in a cumulative 15,000 additional slots by the end of the five-year period.
- Students pursuing a “shortage specialty” like primary care would have an advantage. Of the 3,000 new spots created each year, at least 1,500 of these positions must be used for a shortage specialty residency program as defined by the Health Resources and Services Administration. This distribution would apply until the National Health Care Workforce Commission issues a report on specialty shortages.
- Factors like neighboring medical schools and the number of residency applicants for a particular program will impact how new residency slots are distributed. Programs will be prioritized for receiving funding for new positions in the following order:
- Hospitals in states with new medical schools
- Hospitals that have exceeded their resident cap at the time of enactment
- Hospitals that are affiliated with Veteran’s Health Administration medical centers
- Hospitals that emphasize training in community health center or community-based settings or in hospital outpatient departments
- Hospitals that are determined to be meaningful users of electronic health records for the fiscal year
- All other hospitals
- The act calls for additional research on specialty shortages and diversity in GME. The bill would require the National Health Care Workforce Commission to conduct a study of the physician workforce. The study will identify the main specialties that disproportionally lack physicians; the results would be used to determine which specialties receive priority for residency spots under new GME funding. The act also calls on the comptroller general of the United States to conduct a study on diversity in health care, which would look at new ways to increase the number of physicians in practice from rural, lower income and underrepresented minority communities.
This legislation is timely considering the recent record-breaking number of unmatched students who have graduated from medical school without securing a place to complete their training. Still, students and residents continue to advocate for expanded GME programs, using social media and other tools that call on Congress to #SaveGME.
The AMA also is addressing this issue by continuing its advocacy for federal support of GME. In addition, the AMA is working across stakeholder groups to reduce restrictions to rural and other underserved community experiences for GME programs and encouraging innovative ways to train physicians, with emphasis on physician-led, team-based care.
