Medical school enrollment is at an all-time high, with the number of first year students increasing by 21.6 percent since 2002. The 2014 Survey of America’s Physicians states that by the end of this decade, U.S. medical schools will be producing 27,000 graduates every year.
On the surface, such an increase would seem to go a long way toward alleviating the physician shortage, which the Association of American Medical Colleges (AAMC) projects to reach 131,000 physicians by 2025. One would logically assume that if there are more medical school graduates, then there will be more doctors.
However, most states require at least one year of medical residency training to obtain a license for independent practice, and for the second year in a row, the number of medical school graduates has exceeded the number of residency slots available.
Residency programs are primarily funded through Medicare, which contributes approximately $9.5 billion to fund a share of costs of 100,000 positions in teaching hospitals across the United States. Congress enacted the Balanced Budget Act in 1997, which capped the funding for General Medical Education (GME), effectively freezing the number of medical residency slots available.
While the cap on residency slots has remained stagnant since 1997, the demographics of the United States have changed significantly. With 76 million aging baby boomers reaching the age of 65 at a rate of 11,000 per day, more than 30 million newly insured Americans under the Affordable Care Act, and an ever-growing population, the supply of physicians simply cannot meet the demand of our current and future medical needs.
This past Match Day, the day when medical students find out which residency program they will attend, approximately 975 students received no match at all. If a student goes unmatched, they must wait to reapply the following year. These students may work in pharmaceuticals, spend an extra year in medical school working in a lab, or work in fields unrelated to medicine in an attempt to begin paying off their overwhelming student loans.
AAMC President and CEO Darrell Kirch, M.D., has said, “Increasing enrollments show that medical schools are doing their part to avert the shortage of more than 90,000 primary care specialty doctors this nation faces by 2020.” However, Kirch states that this “will not result in a single new practicing physician unless Congress acts … to lift the cap on residency training positions,” which seems unlikely in the near future.
Most recently in 2013, there were two acts introduced to increase the cap on funding for residency training, the Resident Shortage Reduction Act and the Training Tomorrow’s Doctors Today Act. Both acts failed to pass in the U.S. House of Representatives.
As the composition of healthcare in the United States continues to evolve, new methods for addressing the healthcare provider shortage must be considered, including expanding the role of advanced-practice providers and the use of telemedicine. Waiting for Congress to address the very real need for increased medical residency slots could be a lengthy process.
In the meantime, companies such as Barton Associates are taking on the challenge to provide practical solutions for healthcare organizations that are struggling with the physician shortage.