Recently there has been a lot of talk about the lack of students enrolling in medical studies. The medical school association fears that if this trend continues, we will see a shortage of 90,000 doctors by the year 2025.
Perhaps the greatest foreseen shortfall will occur in the demand for surgeons. In particular, surgeons who treat diseases more commonly found in older adults, such as cancer. ”An increasingly older, sicker population, as well as people living longer with chronic diseases, such as cancer, is the reason for the increased demand,” Darrell G. Kirch, the AAMC’s president and chief executive, told reporters during a telephone news briefing.
The Association of American Medical Colleges (AAMC) has feared a doctor shortage for the past few years, which is why they have been making efforts to support legislation that would funnel more federal money toward its members. These members include 400 of the nation’s teaching hospitals and 141 medical schools. The legislation – Resident Physician Shortage Reduction Act of 2011 – was proposed for a second time in 2013 and calls for Congress to provide $1 billion a year to support 3,000 more medical residents at hospitals.
Since 1965, Congress has used Medicare and Medicaid to assist in funding the one-year residencies that 28,000 medical school graduates complete each year at the nation’s top teaching hospitals. On average, it takes about $152,000 to train a resident and the government reimburses hospitals for a portion of that cost through payments in a program called Graduate Medical Education (GME). In 2012, $5 was spent on GME, which was solely funded by Medicare, according to the Institute of Medicine. A fact sheet accompanying the estimates says that since 1997, Medicare support for doctors in training has not grown, despite an increase in the number of residents.
Criticized for “wasteful spending” and “lack of accountability”, the AAMC is having difficulty arguing their case to unfreeze GME funds. Teaching hospitals must report back on how the money is used and could lose it if their residents drop out or don’t pass their boards. Indirect payments, on the other hand, require no reporting or performance-based standards.
Although it is difficult to know exactly how teaching hospitals are spending the indirect payments, the Medicare Payment Advisory Commission (MPAC), which regularly reviews aspects of Medicare in order to advise Congress, has found that $3.5 billion of these payments are being spent on things unrelated to the training of new doctors. MPAC advises the money be rerouted to a transparent fund that would reward the most productive residency programs and thus put the funds to their best use.
Over the next 10 years, the number of Americans over the age of 65 is expected to increase by 36 percent. In addition, 32 million younger Americans will become newly insured as a result of Obamacare. The scary part is that the number of doctors to treat those Americans will grow by only 7 percent, according to the AAMC.
Access to care could get worse for some people before it gets better, said Dr. Andrew Morris-Singer, president and co-founder of Primary Care Progress, a nonprofit in Cambridge, Mass. “If you don’t have a primary care provider,” he said, “you should find one soon.”
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