Why the U.S. faces a doctor shortage
Posted on: 9/1/2014

Published in the Chicago Sun-Times on September 1, 2014

Joint letter from ISMS and Chicago Medical Society leaders

Each July, a new group of medical school graduates begins residency training. Lasting from three to seven years, this hands-on training period is known as graduate medical education (GME), and it is critical to becoming a physician. Medical school graduates cannot practice medicine without completing residency training. Illinois hosts thousands of medical residents who are part of our health network providing patient care.

Residents often train at teaching hospitals, which provide 40 percent of all charity care in the United States. These hospitals also care for 28 percent of all Medicaid patients admitted to the hospital.

Most people don't realize that most residency training positions are funded through the Medicare program. The federal government spends roughly $11 billion annually to support the education of our medical residents. The public benefit of Medicare's investment spans the entire health system: Doctors are able to master their specialty, hospitals obtain access to a low-cost professional work force, and patients have access to necessary care provided by doctors-in-training.

Unfortunately, federal support for the residency training system comes with certain limits. In enacting the Balanced Budget Act of 1997, Congress capped the number of residency positions at 94,000 and has not since adjusted this ceiling. Since then, the U.S. population has surged by 40 million people, but there has been no growth in the resident training pipeline. Thus, the ratio of doctors serving patients has shrunk significantly, often leading to long waits for medical care or even a lack of access to physicians in some communities across America.

The U.S. is facing a 90,000 physician shortfall by the end of this decade. Medical schools have already reacted by significantly ramping up enrollment, and a number of new schools have been opened. However, medical school alone does not prepare a physician for independent practice, so the bottleneck of newly minted doctors unable to find a medical residency program because of an insufficient number of positions is expected to grow.

The next steps for ensuring access to physicians again rest in the hands of Congress, which must act to increase the residency position limit or consider other reforms to support funding of graduate medical training.

Several solutions have already been introduced in the U.S. House and Senate, but these initiatives need momentum to pass. Three bills in Congress (HR 1201, HR 1180, and S 577) would "uncap" the limits and add 15,000 Medicare-funded residency positions. The Chicago Medical Society, the Illinois State Medical Society, and all of Illinois' medical schools have endorsed the bills, including one sponsored by Illinois Congressman Aaron Schock.

Now is the time for urgent and immediate action from our elected lawmakers. The future of health care access is at stake.

Dr. Kenneth G. Busch is president of the Chicago Medical Society. Dr. Kathy M. Tynus is chair of the Chicago Medical Society Council. Dr. Robert W. Panton is immediate past president of the Chicago Medical Society. Dr. Paul H. DeHaan is chair of the Illinois State Medical Society. And Dr. William A. McDade is president of the Illinois State Medical Society.

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