GME Funding: How to Fix the Doctor 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 are on pace to increase enrollment by 30 percent, 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 2017 study conducted for the AAMC by IHS Inc., predicts that the United States will face a shortage of between 40,800-104,900 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 train at least 3,000 more doctors a year by lifting the cap on federally funded residency training 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 and Congress must succeed in these efforts in order to ensure that there are enough physicians for our growing and aging population.

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, that 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.

Understanding the Doctor Shortage
Watch the AAMC's Atul Grover, MD, PhD and Janis Orlowski, MD explain the causes and effects of the projected doctor shortage.

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.

GME Legislation
Proposed legislation to increase the number of federally funded residency slots.

115th Congress (2017-2018)

114th Congress (2015-2016)

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.