It can be intimidating for medical students still struggling to make their way in the field of medicine to be forceful advocates with the powerful people in state legislatures and in the nation’s capital. That is where the AMA Medical Student Advocacy Conference comes in handy, offering an abundance of training and education to help medical students hone the leadership skills needed to successfully advocate for the policy fixes needed to reshape the future of medicine for the better.
Over the past 30 years, the big jump in medical school enrollment has greatly outpaced the number of available residency positions. The lack of growth in graduate medical education (GME) positions—which are largely funded by Medicare—has created an ultracompetitive Match process for medical students and a barrier to addressing current and impending physician shortages.
The need for more GME slots was a major focus of this year’s AMA Medical Student Advocacy Conference, held in Washington, D.C. Prior to medical students’ visiting Capitol Hill to advocate for H.R. 2389/S. 1302, the Resident Physician Shortage Reduction Act, which is bipartisan legislation to boost the number of Medicare-supported GME positions by 14,000 over seven years, a conference education session offered insight on the problem and how students can effectively argue for a solution in conversations with lawmakers. Here are some key takeaways.
Understand the problem: GME caps
The number of positions that Medicare will support is based upon the number of people that were in training in 1996. The lack of growth in residency positions has been a contributing factor to the physician shortage, and with nearly 45% of active physicians in the U.S. 55 or older the shortage is going to get a lot worse. The U.S. is facing a shortage of up to 86,000 physicians by 2036—a deficiency that is almost certain to be made worse by rising rates of physician burnout and early retirement.
In addition, if communities that are currently underserved by the nation’s health care system were able obtain care at the same rate as populations with better access to care, the U.S. would need approximately 202,800 fully practicing physicians, as of 2021.
GME caps have also created a far more stressful and disjointed residency-selection process, according to Alexis Pierce, senior attorney in the AMA Division of Legislative Counsel.
“There's been an increase in medical school enrollment—52% since 2002—with a growth of only 1% per year in residency slots in that same time frame,” Pierce said. That means [medical students] are having to compete a lot harder to get those slots. The average person in 2021 submitted almost 73 applications. That's a 24% increase from 2017. It's creating this unnecessary rush for these positions, which really shouldn't exist.”
Christopher Sherin is the AMA's assistant director of congressional affairs. He advised medical students to start out by offering this background and to keep in mind that meetings are typically in the 30–40 minute window of time that is part of a busy schedule. Because of that, it’s important to keep the audience engaged by asking questions such as, “does that make sense?”
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Know the solution: Adding slots
There has been some recent movement to help address the lack of growth in physician residency positions in recent years.
Congress made an initial investment in shoring up the physician workforce by providing 1,000 new Medicare-supported GME positions in 2021, marking the first increase of its kind in nearly 25 years. Another 200 federally supported GME positions for residencies in psychiatry and psychiatry subspecialties were added last year.
Additional increases, however, are still needed to address the ongoing dearth of physicians. The Resident Physician Shortage Reduction Act, which the AMA supports, would provide 14,000 new Medicare-supported GME positions over seven years. The slots would be focused on hospitals with diverse needs, including rural teaching hospitals and hospitals serving patients in health-professional shortage areas.
“The fact that there has been movement over the past few years means that when you walk into Capitol Hill to see them [members of Congress and their staffers], they have been thinking about this issue,” Pierce said. “They have shown a willingness to act on this issue and are having discussions.”
Be ready to ask: Will you co-sponsor?
The initial request is straightforward, said Sherin.
“With the Resident Physician Shortage Reduction Act, it's a simple ask,” Sherin said. “You can say it at the beginning, you can say it at the end, but you've got to say it, and the more times you say it, the better. You need to ask representatives to co-sponsor H.R. 2389 [PDF], the Resident Physician Shortage Reeducation Act. Say the bill number, say the title … you do the same thing with the Senate. We want you to co-sponsor the Senate bill, S. 1302 [PDF].”
The legislation already has gathered more than 100 bipartisan co-sponsors.
“Every single visit is essentially a sales pitch,” Sherin said. “You're selling ideas, so remember that. You need to act like you're selling ideas. You need to engage them, and you need to be knowledgeable. This is an opportunity to basically plead your case, which is great.”
