Medical training suffers clogged artery: funding for residencies trails demand

Dr. Ramin Pirouz spent much of the last three months sifting through more than 440 applications for open residency spots at Long Island College Hospital in Brooklyn.

The chief resident and his colleagues conducted more than 300 interviews, with each applicant wooing them in his or her own way for a coveted spot at this medical teaching facility. Most sent thank-you notes. An especially eager candidate sent chocolates. The pool was large and qualified, but in this field, demand increasingly outpaces supply. The hospital — which may close before the residents’ three-year term is even completed — had just 21 first-year positions to offer.

Dr. Ramin Pirouz of Long Island College Hospital interviewed more than 300 candidates for just 21 medical residency positions. Photo: Ana Komnenic

The same situation is playing out across the country. This year, 528 graduating medical-school students did not find a slot, compared to 262 last year.

Another 28,000 found a training position. But the doubling of residency-less medical students foreshadows trouble for the profession and for patients. Medical schools have increased enrollment in anticipation of rising demand for doctors. A shortfall of funding for residencies could strand many future doctors-to-be: they’ll earn medical degrees, but without enough residency positions to go around. And a doctor cannot obtain a license to practice without completing a residency.

Funding for medical residencies, most of which comes from Congress via Medicare, remains frozen at 1990s levels, and is only getting scarcer.

“We are very concerned that starting about 2016, there will be a lot of folks graduating from medical school that do not have a training spot that’s vital for them,” said Christianne Mitchell, a spokeswoman for the Association of American Medical Colleges.

Those cuts are hitting New York hospitals especially hard. One in every six new doctors nationwide does a residency somewhere in the state, which has the largest graduate medical education system in the nation. Residents perform vital patient care in hospitals, and fewer of them could mean longer waits to get medical attention, especially from specialists.

The residency shortage is expected to hit just as demand for physicians reaches its highest point yet, with the expansion of insurance under health care reform and an aging population.

By 2020, there will be 45,000 too few primary care physicians and 46,000 too few surgeons and medical specialists to care for the growing number of patients, predicts the American Association of Medical Colleges Center for Workforce Studies. New York City is already seeing such shortages among primary care physicians: some 1.2 million Medicaid eligible New Yorkers are already considered medically underserved, even as more than million new patients are expected to gain insurance in the state.

Three of New York’s federal lawmakers are stepping up in response. Last month, Reps. Joseph Crowley and Michael Grimm reintroduced a bill to increase federal funding for medical residency positions. Sens. Charles Schumer of New York, Harry Reid of Nevada and Bill Nelson of Florida concurrently introduced the bill in Senate. The Resident Physician Shortage Reduction Act of 2013 would increase the number of residency positions nationwide by 15,000 — a 15 percent increase from the number of spots up for grabs in 2013. In New York, it would provide enough funding for New York state to train an estimated 500 additional residents annually.

“Our country needs us to do all we can to alleviate the coming doctor shortage, yet an outdated limit on the number of doctors that can be trained ties the hands of our medical schools and our teaching hospitals,” said Rep. Crowley in a press release.

The bill faces obstacles. Last year, a similar bill from Crowley died in committee while Congress wrestled with gridlock over sequestration and raising the federal debt ceiling. And just about every deficit-cutting proposal being floated around Washington targets graduate medical education for billions of dollars in savings. The latest Simpson-Bowles plan, the broad effort by President Obama’s Deficit Commission to reduce the federal deficit, proposes $28 billion in cuts to medical education across the nation, which could slash more than $1 billion from New York Sate.

“States like New York and Massachusetts and California have a long history of producing physicians for the entire country, not just their state alone. They’re really the source of doctors for every state in the country,” Mitchell said. “Whether they can continue to maintain that position and that role in light of cuts in federal support is very unclear.”

The Greater New York Hospital Association, a trade group, argues that the federal government needs to make major moves now, rather than waiting until the shortage hits teaching hospitals hard. It takes at least three years to train medical school graduates.

“One thing we know with expansion of health insurance is that when people get health insurance they start to access health services, as they should, and we need physicians who are going to be able to take care of them on an ongoing basis,” said Tim Johnson, a spokesman for the association. “And that leads back to the residency issue and the artificial cap that we think is inappropriate.”

There are alternatives to increasing federal spending. The Center for American Progress calls on private insurers to pick up their share of the tab on medical residencies. The Greater New York Hospital Association agrees that private insurers, whose contribute funds to hospitals’ residency programs on a negotiated case-by-case basis with the hospitals, need to step up their spending.

“Our hospitals are not running Medicare hospitals, they’re not running Medicaid hospitals, they’re running hospitals and have a variety of patients coming in with all different kinds of health insurance,” Johnson said. “Certainly commercial health insurance plans should be making sure that they’re covering the cost of training residents also.”

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