Is a Crisis in Physician Manpower Looming? Save

CNN has reported that changes in immigration policies is but one of many factors that may add to an existing doctor shortage. This and other events now begs the the question, why the federal government doesn't train more doctors in the US?

Currently there are funding limits to federal funding of medical residency programs,that have been capped by the 1997 Balanced Budget Act, and primarily financed by Medicare (~$10 billion).

Many have expected that the cap was going to be lifted, Even more are calling for change in light of the deficit of incoming foreign born physicians and traininees. Attempts at passing legislation to remove the cap have been unsuccessful.

The deficit has occured inspite of US Medical school enrollment increasing 27% between 2002 and 2016. Because of the cap, this did not result in 27% more US doctors. Instead, the number of international doctors entering US programs went down,while number of US graduates who were not accepted went up.

A new analysis commissioned by the Association of American Medical Colleges predicted a doctor deficit of 40,800 to 104,900 by the year 2030.

Even with the increase in American medical students, there are fewer of them than there are residency spots.
Last year, just over 18,000 graduating MDs vied for nearly 28,000 first-year residency slots. The remaining gap is filled by osteopathic medical school graduates and by foreign doctors and US citizens who have studied abroad, many in Caribbean medical schools.

Access to healthcare is not evenly distributed. Many foreign doctors practice in rural, underserved and primary care settings, where medical care is often lacking.  according to the Association of American Medical Colleges. The current Conrad 30 J-1 Visa Waiver program recruits foreign doctors to work in rural and medically underserved areas that may be less desirable to many American-educated doctors.

Thus there is a serious shortage of primary care and rural doctors that is driven by doctor preference, differences in salary, work hours and lifestyle.  This deficit is not just for primary care doctors, but also general surgery and psychiatry.

In 2014, the Institute of Medicine released a report arguing against a change in residency funding. The report, which denied an overall doctor shortage, called for other major changes to residency training, such as weaning slowly off Medicare and reconsidering whether residents train predominantly in teaching hospitals.

Current paradigms for training physicians are being threatened includig access to good trainees and ample funding and training sites/resources.