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Different Solutions for the Physician Shortage

Different Solutions for the Physician Shortage

Even as physicians are busier than ever, some with exceedingly heavy panels, the Association of American Medical Colleges (AAMC) has alarmingly concluded that physician demand will exceed supply by 2030. AAMC, a Washington, D.C.-based non-profit focused on medical research and education, predicts shortages in primary care between 61,700 and 94,700 physicians by 2025, and as high as 60,300 for non-primary care specialties.

Jason Farr, a Texas-based recruiter with The Medicus Firm, a national physician recruiting firm, remembers hearing about a physician shortage coming over a decade ago, centered around primary care and rural areas. "Fast-forward here we are a decade later and it is as real as can be," he says.

There are a number of reasons for this shortage, ranging from baby boomer aged physicians facing retirement, as well as an influx of patients aging and needing more medical care. Millennial physicians are more concerned about the work-life balance than their older counterparts, leading them to work fewer hours, and many physicians are burning out due to technology and regulatory burdens. Here, experts weigh possible solutions to handle the shortage.

Resources for Residents

One answer to this physician shortfall might appear to be solved by an increase in medical school enrollment. However, training programs for residents and fellows haven't expanded at the same rate, creating a bottleneck in the residency pipeline. According to an annual survey by AAMC, first-year enrollment at U.S. medical schools has increased by 28 percent since 2002. "The real chokehold is in the residency programs," says Fred Jacobs, MD, JD, New Jersey-based executive vice president of St. George's University School of Medicine and former commissioner of New Jersey Health and Senior Services.

Indeed, in 2017, there were a record-breaking 35,969 U.S. and international medical school students and graduates competing for only 31,757 positions, according to the National Resident Matching Program, a shortfall of over 4000 residents-to-be.

"We have a shortage of physicians but a surplus of talent," Farr says.

Funding for residents is expensive, as well, and most hospitals and medical groups do not have extra funds to pay for them or they go way over budget in order to do so. In 1997, Congress capped the amount of funds for Medicare support for graduate medical education (GME) "at how many residents you were training at the end of 1996," says Len Marquez, Senior Director of Government Relations and Legislative Advocacy at AAMC. This has contributed to the slowdown in the number of medical residents who can enter the workforce. "If Medicare funding isn't expanded to include more GME positions, then there is no other viable source," Jacobs says.

The AAMC is sponsoring legislation that seeks to raise these caps. Two bipartisan bills have been introduced in the House and Senate, Marquez says, that would "over a five-year window, increase the number of Medicare supported GME residency positions by 3000 between 2019 and 2023, with a total of 15,000." This would help with the shortfall, he says.

While the bills are no quick fix since "it's difficult to move legislation right now that costs the federal government money," Marquez says, he's hopeful about the bipartisan support they're gaining and are continuing to educate. "Because it's not like in 2030 Congress can say we need additional physicians and just flip the switch."

Some institutions are creating their own medical-school-to-residency pathways, such as Kaiser Permanente, an Oakland, Calif.-based managed care company, which currently trains 600 residents annually and provides continuing medical education (CME)to another 22,000 medical professionals.

Senior Program Integration Manager for the newly forming Kaiser Permanente School of Medicine, Aldina Washington, MBA, says by email, "We are currently in the very preliminary stages of developing the school, starting with establishing an organizational structure and beginning the accreditation process."

Farr says it's the beginning of a process that he expects will grow as hospital systems and medical groups become desperate to fill physician gaps. "They're just going to start saying 'we're going to train ourselves,'" he says.

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