Without increase in residency programs, nation faces doctor shortage
Citizens' Voice, The (Wilkes-Barre, PA)
June 17--Despite the spike in medical school enrollment expected by 2017, the nation faces a critical physician shortfall unless thousands of residency training programs are developed, experts and officials said.
Fueled by the expansion and construction of new medical schools, U.S. medical schools are poised to increase their enrollment 30 percent by 2017, according to a study conducted by the Association of American Medical Colleges.
But officials say the surging growth in medical students will do little to stave off impending physician shortages -- that could reach 90,000 by 2020 -- without a hike in residency programs.
The jump in medical school graduates outpaces the projected increase in residency training programs. So, even though there might be enough graduates to put a dent in the shortage, not all will find a match.
Medical school graduates must complete a residency training program before they can practice independently.
"We tried to do the responsible thing by creating new schools, like (The) Commonwealth (Medical College), and expanding class size, but we aren't sure we are going to be able to train them all," said Atul Grover, M.D., Ph.D., chief public policy officer of the AAMC.
Brought to light with the looming physician shortages, officials say the insufficient in-state residency slots have been a concern since the Balanced Budget Act of 1997.
The act capped the number of residents each teaching hospital could claim for reimbursement under Medicare, slowing the development of residency programs throughout the nation.
Since 1996, the number of residency positions has increased by 5,829, or 28 percent, from 20,563 to 26,392, according to the National Resident Matching Program.
During the same time frame, the total applicants seeking residency positions has jumped 38 percent, or 9,637, from 24,718 in 1996 to 34,355 in 2013.
More than a dozen medical schools, including The Commonwealth Medical College in Scranton, recently opened in part to address the aging of the baby-boom generation and impending retirement of many current doctors, officials said.
Lackawanna County's population of people age 65 and older was 17.7 percent in 2010 and 17.9 percent in Luzerne County, according to Census Bureau data. Statewide in 2010, the 65 and older population was 15.4 percent.
"The need in this region is going to grow, and the hope was that this school would train students who come from this area, and therefore, are more likely to return to this area to practice," TCMC President and Dean Steven J. Scheinman, M.D., said.
"I think that will happen. But we could enhance the number of physicians who come here to practice by increasing the number of residency training programs in the region," Scheinman said.
School administrators are working with the Pocono Medical Center in East Stroudsburg in an effort to develop residency training programs, Scheinman said.
Right now, the majority of Pennsylvania's residency programs are found in Philadelphia, though The Wright Center in Scranton trains four students annually, according to the NRMP Program Results from 2009 to 2013.
Geisinger Wyoming Valley Medical Center in Plains Township offers residency programs in family medicine, the report said.
In theory, Scheinman said, the Scranton-based medical school could fund residency programs at hospitals or clinics.
"But we don't have the money," he said.
Finding a main source of funding for residency training programs has been a major roadblock, officials said.
The cost to train a resident hovers between $140,000 and $150,000 annually, though it fluctuates depending on the location.
Teaching hospitals, on average, cover $100,000 of the costs while Medicare contributes about 30 to 40 percent, an AAMC report said.
"That's the nut that has to be cracked; how are we going to pay for this?" said Linda M. Famiglio, M.D., chief academic officer at Geisinger Health System and associate dean of the Temple School of Medicine.
Large organizations, such as Geisinger Health System and Dartmouth-Hitchcock, have been able to grow programs because of their achieved level of success and resources, said Famiglio, who also served as the chair on the Accreditation Council for Graduate Medical Education's Institutional Review Committee, which accredits institutions and allows them to sponsor GME programs.
But small hospitals have a difficult time because of their tight budgets and limited resources.
"Some smaller hospitals are struggling as it is," Famiglio said. "They may have a community mission, but it's hard for them to have the resources.
"Funding is a big obstacle."
Through its advisory group, the Institute of Medicine, Congress is researching ways to fund residency programs, she said.
The report is expected to be released soon, but in the meantime, "we have to figure out a way to keep our students from being so far in debt," she said.
Some students graduate medical school with $200,000 to $250,000 in debt, Famiglio said.
"It will help the hospitals build more residency programs because they won't be feeling like they are so pushed to increase the salaries of the residents," she said. "And it will help the residents choose fields based on need and passion rather than paying back their loan."
Michael Wolf, secretary of the Pennsylvania Department of Health, said officials must provide "incentives to recruit and retain more primary care physicians and practitioners in rural and underserved areas."
He said Gov. Tom Corbett's budget includes $1 million for expanding the current loan repayment program, which "wasn't as enticing as what other states were offering," he said in a statement to The Times-Tribune.
"We needed to become more competitive," he said in the statement. "This will not only allow Pennsylvania to be more competitive with other states, it will allow residents in rural areas of the state to have consistent access to the same practitioners and build a network of care that will be a much needed, solid resource in these communities."
Another key to staving off a shortage and creating residency slots is the "Training Tomorrow's Doctors Today Act" (H.R. 1201), said Grover of AAMC.
Over a five-year period, the act would create 15,000 additional Medicare-supported residency positions nationwide, at least half of which must be used for a shortage specialty residency program.
"I don't think there is much doubt that we ought to be training more physicians," he said. "Congress ought to act sooner than later. We are going to have 30 million people coming into the health care system next year" because of the Affordable Care Act.
(c)2013 The Citizens' Voice (Wilkes-Barre, Pa.)
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