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Uncapping Graduate Medical Education

The Medicare system is the chief governmental source for graduate medical education (GME) funding. However, the number of Medicare-sponsored GME spots has been capped since 1997 at 94,000. Since that time, the number of Americans has risen by more than 50 million, with the number of Americans over age 65 expected to increase 36% during the next decade.

To meet the medical needs of an increasing and an increasingly aged population, the medical schools have responded by increasing class size. The Association of American Medical Colleges (AAMC) reports the number of first-year medical students at 16,488 in 2002, with an expected increase to 21,376 by 2016.

Despite this increase in medical students, the number of sponsored residency positions has not increased. The result is that the bottleneck for physician supply is in the number of residency positions. The American Medical Association (AMA) has estimated that the number of graduates of American medical and osteopathic schools will exceed the number of sponsored-residency positions by as soon as 2015.

Congressional Proposals

Three major proposals in Congress attempt to correct the situation: HR 1201, S 577, and HR 1180. Each of these bills calls for an increase of 15,000 Medicare-sponsored residency positions over a three-year period. Moreover, the bills encourage development of new residency positions in medical shortage areas, including primary care.

All three bills have been endorsed by the AAMC (Association of American Medical Colleges). As with so many bills in Congress, the chief obstacle is funding. Current funding for GME is $9.5 billion for 94,000 sponsored positions, or about $101,000 per position. If the same funding level is maintained, an additional $1.5 billion would be needed for the 15,000 additional positions.

In Congress there are also discussions about scope of practice issues. Many legislators view the problem of physician shortages in the broader context of physician numbers and the workforce effects of physician extenders.

CMS/ISMS Efforts

Uncapping GME has been one of the key advocacy efforts of the Chicago Medical Society (CMS) and the Illinois State Medical Society (ISMS). Society leaders traveled to Washington, DC, in February and July 2013, to discuss the matter with the Illinois Congressional delegation. The second trip also included Dimitri Azar, MD, Dean, UIC College of Medicine.

Congressional leaders have encouraged the major state medical societies and medical schools to formulate common positions about GME that could then be distributed to the Illinois Congressional delegation.

Medical students are also active in letter writing campaigns, emphasizing that increased GME would help meet our workforce needs. The students also have the unique perspective of being saddled with significant levels of debt and the anxiety of not knowing whether a residency position will be available when they graduate. Bloomberg News reported that the 2012 median medical school graduate debt was $170,000.

The Chicago Medical Society and the Illinois State Medical Society recognize that the GME residency caps of 1997 are too low to meet the increasing demand for physician services. The Societies encourage an additional 15,000 Medicare-sponsored residency positions, with an emphasis on medical shortage areas, including primary care. Future publications will update you on this issue as it winds its way through Congress.

Robert W. Panton, MD
President, Chicago Medical Society

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