GME Funding and Its Role in Addressing the Physician Shortage

The Issue

The United States is facing a serious shortage of physicians, largely due to the growth and aging of the population and the impending retirements of older physicians. While medical schools have increased enrollment by nearly 30% since 2002, the 1997 cap on Medicare support for graduate medical education (GME) has stymied the necessary commensurate increases in residency training, creating a bottleneck for the physician workforce.

A 2018 study conducted for the AAMC by IHS Inc., predicts that the United States will face a shortage of between 42,600 and 121,300 physicians by 2030. There will be shortages in both primary and specialty care, and specialty shortages will be particularly large.

These shortages pose a real risk to patients.  Because it takes up to 10 years to train a doctor, projected shortages in 2030 need to be addressed now so that patients will have access to the care they need.

The Solution

Fixing the doctor shortage requires a multi-pronged approach. This includes innovations such as team-based care and better use of technology to make care more effective and efficient. AAMC-member medical schools and teaching hospitals have been leading the movement to work better in teams with other health professionals like nurses, dentists, pharmacists and public health professionals. These institutions also are developing the new knowledge of what works in health care – not only reading the textbooks – but writing the textbooks to advance the delivery of care.

Even with all of these changes, the data clearly show that reforms alone will not eliminate the doctor shortage.

As part of the multi-pronged approach to alleviating the doctor shortage we also need additional federal support to produce about 3,750 more doctors a year by lifting the cap on federally funded residency training positions. Teaching hospitals are operating 10,000 residency positions without Medicare support, but cuts to Medicare and other clinical reimbursements jeopardize the ability of teaching hospitals to cross-subsidize with clinical revenue these positions.

The AAMC strongly supports bipartisan GME legislation introduced in both the House of Representatives and the Senate, the Resident Physician Shortage Reduction Act of 2017 (H.R. 2267; S. 1301), which takes an important step towards alleviating the physician shortage by gradually providing 15,000 Medicare-supported GME residency positions over a five-year period. However, legislation alone will not relieve the doctor shortage.

In addition, the AAMC supports non-GME incentives and programs, including Conrad 30, the National Health Service Corps (NHSC) and Public Service Loan Forgiveness (PSLF), and Title VII/VIII, which are used to recruit a diverse workforce and encourage physicians to practice in shortage specialties and underserved communities.

Resources

Policy Priorities to Improve Our Nation’s Health: Physician Workforce Issues
An outline of key GME and workforce challenges and opportunities facing academic medicine.

The Nation's Physician Workforce and Future Challenges
A special feature appearing in the January 2016 issue of The American Journal of the Medical Sciences written by AAMC Executive Vice President Atul Grover, MD, PhD; AAMC Chief Health Care Officer Janis Orlowski, MD, MACP; and Clese Erikson, MPAff.

Graduate Medical Education: Training Tomorrow's Physician Workforce
A one-page summary of the roles of teaching hospitals and federal support for residency training and how they impact the physician shortage.

Myths and Facts: The Physician Shortage
An explanation of some of the key points about the physician shortage.

GME Payment Primers
A series of motion graphic videos that provide an introduction to Medicare and GME reimbursement and explain some of the complicated regulatory processes related to how GME payments work.

Medicare Indirect Medical Education (IME) Payments
An explanation of IME payments, which provide an additional payment to a teaching hospital for every Medicare case paid in recognition of the extra costs teaching hospitals incur in caring for patients as part of their teaching mission.