Posted by Mark Ryan, MD July 10, 2011 at 10:28 PM
If the Patient Protection and Affordable Care Act (PPACA) remains the law of the land after its inevitable Supreme Court review, then an estimated 34 million Americans will gain access to health insurance. Once they have access, they will seek to establish medical care: perhaps to get a physical, to get care for chronic diseases, or to help figure out a symptom or problem.
However, when those newly-insured would-be patients go and seek to establish care with a physician, they will find a major roadblock: the Association of American Medical Colleges (AAMC) is predicting that between this increase in the insured population and the continued increase of Medicare-eligible Americans, the United States will find itself short nearly 63,000 physicians. Nearly one-half of this shortage (33,000) is expected to be in primary care specialties. (PDF) In its report, the AAMC calls for increase in residency training slots to address this coming crisis.
At the same time, part of the current budget debate includes making significant restrictions to Medicare funding as a way to try and balance the books. As I noted before, Rep. Paul Ryan has proposed a budget that would drastically change how Medicare is run, and some in Congress are calling for Medicare cuts as part of any deal to increase the national debt ceiling (and prevent defaulting on our national debt).
As difficult as these two issues are separately, there is a connection: Medicare funding pays for majority of physicians’ post-medical school training. In other words, medical school graduates who continue their training to specialize in most fields–primary care or superficiality–will be paid for from Medicare funds. So: any cuts to Medicare will reduce our nation’s ability to train new physicians, at the very time when we desperately need to train new physicians.
I mentioned earlier that the AAMC is calling for an increase in residency training slots. Now the Accreditation Council for Graduate Medical Education (ACGME) is calling attention to the terrible results cutting Medicare funding for residency graduate medical education (GME) could have: (pdf)
- Institutions with only one GME program–often primary care, often in community settings, often involved in direct patient care, and often rural–would risk losing their programs if they cannot find other ways to fund them.
- Institutions with more than one program may opt to redistribute GME training slots away from primary care and toward income-generating programs and more procedure-focused such as specialized surgery, cardiology, etc.
- Institutions seeking to find new funding for GME slots may look to the pharmaceutical and medical device industries to help make ends meet. Given the harm that can result from such industry connections, it might be argued that training in this environment would not produce the best physicians.
- Residents and others in GME programs may be charged tuition (instead of being paid) for furthering their education, which may worsen the pull away from the very primary care specialties we desperately need.
- Residents’ learning environments, work hours, and supervision could be impacted, as expected GME funding to make training safer and more effective would no longer be forthcoming.
- The increased pressures on residents–financial, workload, etc–could result in more residents choosing not to complete their training.
We already face a crisis in our physician workforce, and we will face enormous problems providing health care if Medicare funding is reduced as part of a political deal. But put the two together: an urgent need to train more physicians, and cuts in the very training programs we need…and the potential long-term damage is even more frightening. The potential harm is even more alarming when you consider the current need to increase our primary care workforce, and the fact that these GME cuts stand to disproportionately harm those GME programs.
The ACGME is calling for attention and for action, as is the AAMC. All of us–physicians, patients, families, friends, constituents–need to be doing the same.
Call your representatives in Congress, or write them, or e-mail them. Use this link for the House, and this link for the Senate. The message must be clear: Medicare cuts are unacceptable. They will deprive our nation’s citizens of the care they need now, and they imperil healthcare access for all of us–for decades to come.