Guest post from Jason Fodeman, MD
This summer new doctors will start their residency training in a host of hospitals across Arizona and across this great nation. These new doctors are entering medicine at a time when uncertainty about the future of medical practice is at an all-time high. Much of this is a result of the Affordable Care Act, yet other uncertainties remain; including ambiguities about the future of the very funding that supports residency training.
As Congress looks to curtail out of control government spending and rising deficits, one expenditure that has repeatedly drawn interest is funding for Graduate Medical Education (GME). The Super Committee, the Simpson-Bowles Commission, and the Medicare Payment Advisory Commission have all paid particular attention to this funding that supports the mandated training doctors must complete at regular intervals in the years after graduation from medical school. While budgets must be tightened, cuts to GME would endanger patients.
A recent study by the Accreditation Council for Graduate Medical Education (ACGME) attempted to quantify the devastating effects of possible GME cuts. The authors found that a 33 percent funding reduction would lead to the closure of 1,639 residency/fellowship programs and a loss of 19,879 post-graduate training positions. A 50 percent reduction in funding would cause 2,551 training programs to close and lead to the elimination of 33,023 training spots.
Since all physicians must complete residency training before being able to practice, fewer residents in the pipe-line, will ultimately translate into fewer practicing physicians. Thus GME cuts will inevitably exacerbate the physician shortage, which the Center for Workforce Studies puts at 91,000 primary care physicians and general surgeons by 2020.
As a result patients will have an increasingly difficult time receiving the care that they need and want as they will not be able to find doctors. It is likely that those patients on Medicaid and Medicare who already experience trouble finding treatment, will be affected the most.
This will create a serious access problem for those patients desperately seeking care. At the same time, those patients fortunate enough to arrange a medical appointment will likely see their face time with a doctor diminished, as physicians will have to see an increasing number of patients in a day to overcome the dwindling supply of doctors. Patients will likely find it very frustrating when physicians do not have the time to have their questions answered or understand the treatment options. This could easily foster a more paternalistic approach to medical care and put patients at risk.
Cuts to GME will be a detriment to the quality of life and quality of training for medical residents as well. Despite the work load of completing a residency, life does not stop for these young doctors. Residents have personal, professional, family, and social obligations outside of residency. Yet, fewer spots means that there will be fewer positions in the city or region where a resident may want to work or where a resident may need to be.
The 80 hour work-weeks and 28 hour shifts of residency are demanding enough, but residents should not have to also suffer through that while being separated from their spouse because the closest spot to their partner in Texas was one in Connecticut. Unfortunately, due to a limited supply of opportunities this already happens and will only become more prevalent if GME funding is cut. This will not only create unnecessary personal and professional hardships for young doctors but also lower morale, both of which could distract a resident from his or her education and jeopardize patient care.
The timing for cuts to GME could not be worse. As more and more of the baby boomers find themselves on Medicare and as the health care reform law adds millions to Medicaid, more residents, not less, will be needed to ensure that these patients receive the necessary care.
In fact, our health care system already lacks an adequate supply of doctors to meet demand. This is, in part, attributable to Congress’ short-sighted decision to cap residency funding in the 1997 Balanced Budget Act. To double down on this flawed policy now by further cutting GME would be penny-wise and pound-foolish. This would create critical access problems for patients and lower the quality of care available across-the-board. Inevitably, the sickest and poorest patients would be harmed the most.
A better prescription would be for Congress and the federal Department of Health and Human Services to work with hospitals and health care providers to invest in residency training programs and increase the number of spots. The fate of our health care system depends on it!
Jason D. Fodeman, M.D. is a board-certified Internal Medicine doctor practicing in Tucson. He is a graduate of the Cedars Sinai Internal Medicine residency program and completed a graduate health policy fellowship at the Heritage Foundation.