The bills, S. 2892 and H.R. 3414, have bipartisan support and would increase funding to Medicare to pay for residencies in addiction medicine, addiction psychiatry, and pain management.
The legislation is separate from the Resident Physician Shortage Reduction Act of 2019, introduced earlier this year, which would fund 15,000 new residency positions over five years starting in 2021.
Government Controls Doctor Supply
The Association of American Medical Colleges (AAMC) projects the United States will be short 121,900 physicians by 2032. Medicare funds nearly all residency positions in the country, and the number allowed has not risen for more than two decades.
The residency cap is the main cause of the physician shortage, says Merrill Matthews, a resident scholar at the Institute for Policy Innovation.
“The number is capped at 100,000 in legislation that passed in 1997,” said Matthews. “Government rations the spots. The funding demonstrates all the problems associated with the government running health care: rationing and political pressure.”
Although the bills to address the opioid crisis will increase the number of positions, they will have little effect on the overall problem, says Matthews.
“The expansion appears largely limited to residents focusing on addiction medicine and related fields,” said Matthews. “It’s the government responding to political pressure to address certain problems.”
Disconnect with Medical Schools
While the number of residencies has remained stable, medical schools have been training more doctors, with enrollment rising by 31 percent since 2002. A July 2019 AAMC report states 44 percent of the nation’s medical schools have major to moderate concerns about their inability to place graduates in residency programs.
The shortage of residencies is disastrous for prospective doctors, says Jane Orient, M.D., president of the Association of American Physicians and Surgeons.
“Reportedly, there are 8,000 medical school graduates every year who do not ‘match’ with a residency position,” said Orient. “This means they cannot work as a physician, despite having gone $200,000 into debt for their education.”
The shortage of residencies puts medical school graduates on the sidelines to wait for a chance at a residency.
“Only Missouri has an ‘assistant physician’ license permitting practice in association with a licensed physician,” said Orient. “This does not yet have a path to licensure. These physicians must still try to match, with dwindling chances every year.”
Central Planning Problem
The mismatch between the numbers of medical school graduates and residencies is another example of government central planning going haywire, says Orient.
“We believe there were previously many privately funded residencies in private hospitals,” said Orient. “We need to find out what happened. Inability to get accredited to offer board certification? Disappearance of independent hospitals? Why should residency funding depend on the insolvent Medicare program?”
Like Matthews, Orient questions why Congress needs an opioid crisis before responding to the residency problem.
“The government seems focused primarily on addiction specialists, but all kinds of physicians are needed,” said Orient. “And why do you have to have special certification to prescribe medication-assisted treatment for addiction? Other physicians could do the job but are not legally permitted to do so.”
AnneMarie Schieber ([email protected]) is managing editor of Health Care News.
Kevin Dayaratna, Ph.D., John O’Shea, M.D., “Addressing the Physician Shortage by Taking Advantage of an Untapped Medical Resource,” May 30, 2017, The Heritage Foundation: