In the last two years, more than 16 million Americans, many of whom never had insurance, received health care coverage via enrollment in Obamacare health exchanges and Medicaid expansion. The passage of the landmark health care law and subsequent explosion in insured patients has raised questions about health care infrastructure’s ability to support an influx of new enrollees.
While an impending doctor shortage has been a topic of discussion in years past, a study by the Association of American Medical Colleges (AAMC) released in March projected a shortage of as many as 90,000 physicians in the next 10 years. The greatest demand, the report said, will be among surgeons, especially as increasingly older baby boomers clamor to mitigate chronic illness.
Since then, medical schools and groups have geared up to address the gap. While she admits closing the physician gap will require more than one solution, Tannaz Rosouli, director of government relations at AAMC, said enrollment caps for residency programs imposed by Congress require immediate attention. In her role, Rosouli has lobbied for such changes, arguing that they have impeded efforts to efficiently prepare a greater number of future doctors.
“As people age, they demand primary and specialty care. Rosouli told ThinkProgress. “The need is increasing but the supply isn’t growing at the same pace. Schools have been doing their part. Medical programs have been receiving a high number of applicants and expanding class sizes. However, residency programs haven’t been able to expand because of a cap that Congress imposed 20 years ago. That’s where we need to increase the opportunity.”
As outlined in the Balanced Budget Act of 1997, Medicare expenditures for residency programs can’t surpass $9.5 billion annually. Congress hasn’t increased the mandated amount since then, even as nearly 20 medical schools opened since the turn of the decade. National first-year medical school enrollment surpassed 20,000 in 2013, placing more pressure on students eager to transition to the next step of their educational journey. That year, more than 500 medical school graduates went unmatched because of a lack of slots for residencies.
In May, a bipartisan coalition of lawmakers introduced a bill that, if passed, would increase the number of graduate medical education slots at teaching hospitals within the next five years. Under the legislation, titled the Resident Physician Shortage Reduction Act of 2015, highest priority would be given to hospitals in states with new medical schools, medical facilities that have exceeded their resident cap, and hospitals affiliated with the Veteran’s Health Administration medical centers.
However, some medical residency programs have decided not to wait on the federal government. For instance, Nova Southeastern University of Osteopathic Medicine in Ft. Lauderdale, FL collaborated with the state department of corrections to allow board-certified doctors to enter its correction-based psychiatric residency. Since 1974, Maryland has supported its residency programs with money collected from private insurance plans. In 20132, lawmakers in California proposed a $5-per-life fee for insurance companies that will subsidize residency programs.
While some experts agree that increasing medical residency slots would take some steps in meeting the national demand for doctors, some medical school professors say there are other factors to take into consideration, the most important being where medical students practice once they complete their studies.
A policy brief by the American Academy of Family Physicians (AAFP) showed that there are less than 70 primary care physicians for every 100,000 people living in rural communities compared to 84 doctors per 100,000 residents in metropolitan areas. The dearth of medical professionals have closed hospital closures, the most recent being Mercy Hospital in Independence, KS. The shuttering of that facility leaves residents with alternatives more than 15 miles away.
Meeting the demand for physicians and keeping hospitals open may also require keeping in mind which medical fields that students enter. The percentage of the physician workforce entering primary care, the first point of contact for patients, fell to an all-time low, AAFP President Robert Wergin told reporters earlier this year. Fulfilling U.S. Surgeon General Vivak Murthy’s goal of creating a prevention-focused health care system requires filling that deficit, students are often discouraged from becoming primary care physicians.
In an interview with ThinkProgress, Chicago-based doctor Joel Shalowitz pointed out that many of the lucrative specialty medical fields — including cardiology, oncology, and radiology –attract students burdened by debt, to the detriment of a growing populace in need of primary care physicians. Shalowitz, who said that he too struggled to find an internist for his family practice, said today’s medical school graduates value the allure of a big paycheck over service to others.
“They see that they’re going into a job that often requires filling out paperwork and working long hours just to make one-third of what people in other specialties make,” Shalowitz, clinical professor of health enterprise management at Northwestern University’s School of Management, said. “In interviews, they don’t even ask about the job and advancement opportunities. Instead, they want to know about how often they would go into the hospital, frequency of night calls, vacation. It’s no longer a vocation or profession, but a job.”
In the meantime, if the United wants to solve its doctor shortage problem, it may not have to look any further than Cuba, a country known for its high life expectancy. After Hurricane Katrina devastated New Orleans in 2005, 1,600 Cuban doctors prepared to deploy to the hardest hit areas before the Bush administration refused their assistance. In the post-embargo era, the U.S. can use its improved relationships with the Caribbean nation to its advantage, using their expertise in low-income, low-resource communities as GOOD Magazine’s Mark Hay suggested in June.
“Because of a lack of funding for specialized care, Cuba focuses on developing comprehensive, world-class training in preventative and primary care medicine,” Hay said. “And as Cuban doctors will usually wind up working in low-income areas, they are trained to work with limited resource and in slum conditions, often with patients who may be reluctant or unable to leave their homes or seek help.”