A study by the Association of American Medical Colleges projects a deficit of 46,100 to 90,400 physicians by
2025 due to an aging population requiring more care,
physician retirements, and the Affordable Care Act
potentially introducing 32 million more patients into
the health care system.
4 To counteract this projected
deficit of physicians, the number of domestic medical
school graduates has increased recently. However, this
uptick in medical school graduates has added to the
complexity of the GME conundrum.
The BBA of 1997 was enacted in an era when
health policy experts were projecting an oversupply of physicians. Passing legislation to change the
BBA’s cap on residency positions has proven difficult. Because of the increased number of domestic
medical school graduates and the capped number
of residency positions available, it has become more
difficult for medical students to be accepted into the
residency programs of their choice. When Governors
were asked whether the current level of GME funding should change, 80 percent responded that GME
funding should be increased, 19 percent responded
that GME funding should remain at the same level,
and 1 percent responded that GME funding should
be decreased (see Figure 4, page 30). Responses to
this question did not vary by age of the Governor.
And—although one might anticipate that Governors
who work in academic facilities or larger hospitals
might be more likely to support an increase in GME
funding—the answers did not vary based on practice
setting (academic versus employed physician versus
private practice) or type or size of the hospital where
the Governor works.
Alternative sources of GME funding
For the GME system to be able to produce more physicians to meet U.S. workforce needs, some policymakers
and members of the surgical education community have
suggested that alternative sources of funding should
be developed. New financing mechanisms are necessary for several reasons. First, existing legislation limits
the amount of funding that Medicare can contribute to
GME. Second, Medicaid contributions to GME are not
required under federal law; as a result, some states that
are experiencing budgetary issues are choosing to stop
making Medicaid payments to GME programs.
The ACS Governors were asked to select options
for alternative sources for additional GME funding (see
Table 1, page 30). Their responses did not vary by age
or practice setting, although Governors in smaller hospitals were more likely to favor the option of “regional
sponsorship for a resident’s commitment to practice
in the region for a period of time” in comparison with
Governors in larger hospitals or academic institutions.
Some states are beginning to develop alternative
sources of supplemental GME funding. Although existing teaching hospitals have not received additional
funds to support new residency positions since the BBA
was enacted, residency programs at new teaching hospitals may receive additional DGME and IME funding
if certain Medicare requirements are met.
Georgia, for example, has actively sought to increase
the number of new residency positions available in the
state by helping new teaching hospitals to develop
training programs and by contributing to the start-up
costs of these programs. These expenditures can be significant. Start-up costs are estimated to be $3.88 million
FIGURE 3. TYPE OR SIZE OF HOSPITAL
JUN 2016 BULLETIN American College of Surgeons
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