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Let’s Tackle the Doctor Shortage Now
William A. McDade, MD
ISMS President
William A. McDade, MD, PhD

Last month my hospital welcomed our new class of medical residents. Each young doctor brought an impressive background, similar to the many physicians before them who came to settle in Hyde Park expecting an intensive three-to seven year journey.

A similar welcome occurred all around our state in July. Illinois hosts thousands of medical residents who are part of our health network providing patient care in academic, rural and urban settings.

What's interesting is that, as an institution, my hospital and the other statewide programs have little wiggle room to adjust our residency slots. The reason for this inflexibility is that the number of Medicare-funded Graduate Medical Education (GME) positions has been capped by Congress - despite data suggesting our "medical training pipeline" is too narrow.

In enacting the Balanced Budget Act of 1997, Washington lawmakers capped the number of residency positions at 94,000. Since then our population has grown by roughly 40 million potential patients. But other than a small growth in privately financed GME positions, our training output has been held in check.

Our teaching hospitals provide 40 percent of all charity care in the country, much of it provided by our residents. These same hospitals also care for 28 percent of all hospitalized Medicaid patients.

Medicare-backed GME is a sensible system for many reasons. Doctors are able to master their specialty, hospitals obtain access to a low-cost professional workforce, and patients have access to necessary medical care.

The Affordable Care Act is further growing the need for more doctors as newly covered patients seek care. Some believe the solution for any doctor shortage is to allow our allied health professions (AHPs) to do more. AHPs play an important role on the medical team, but there are limits to what their training allows them to do.

Bringing the message to lawmakers - from Congress to Main Street

It's now time for Congress to increase the number of GME positions or advance other creative solutions to grow our physician supply.

ISMS is working closely with the Chicago Medical Society and Illinois medical school deans to urge Congress to take action now.

Several solutions have already been introduced in the U.S. House and Senate. Three bills (HR 1201, HR 1180, and S 577) would "uncap" the limits and add 15,000 more Medicare-funded residency positions. HR 1201 is sponsored by Illinois Congressman Aaron Schock (R-Peoria), and has picked up bipartisan support from Illinois' congressional delegation.

Recently, ISMS pointed our advocacy efforts outside of Illinois' borders by contacting all state medical societies to engage them on seeking action on this issue.

Now is the time of year we often find our members of Congress in their home districts, shaking hands, walking in parades and seeking your vote.

If you run into your lawmakers at any summer event or over the holiday weekend, tell them we can't afford a doctor shortage due to a "bottleneck" at the residency level. Urge them to pass legislation to upcap the limits on Medicare-funded GME positions. You can also contact your U.S. Representative and U.S. Senators Durbin and Kirk in their district office; find your lawmakers' contact info here.

I'll close with some perspective on the lack of creativity in the Institute of Medicine's recent report on the financing of GME. Their conclusion suggesting that there really is no physician shortage and that there needs to be patient quality metrics attached to GME is dangerous. Because if they are wrong, the lag time in producing a new physician is 7 to 14 years and to scale up will be difficult. Also, the history of our residency teaching programs is that they serve a disproportionately disadvantaged population. Quality metrics tend to be lower for this population and holding residency training accountable for this disparity could lead to less funding for the most vulnerable programs serving the underserved.

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