Growing Mismatch in Med School Graduates, GME Places
Slow growth in graduate medical education positions, mainly due to cap on Medicare funding
TUESDAY, June 25 (HealthDay News) -- Although the number of medical school enrollees and graduates is increasing, the number of U.S. graduate medical education (GME) programs has not increased at the same rate, and consequently physician shortages are likely to become more apparent, according to a perspective piece published online June 19 in the New England Journal of Medicine.
John K. Iglehart, a national correspondent for the New England Journal of Medicine, discusses the mismatch between the increasing number of medical school graduates and the limited number of U.S. GME programs and residency posts.
The author notes that in contrast to increased funding for medical school seats, there has been slow growth in the number of GME positions, with the major obstacle being a payment cap on Medicare funding of advanced training, imposed by Congress in the Balanced Budget Act of 1997. Efforts to increase funding were frustrated during debate over the Affordable Care Act (ACA). In the 2009 to 2010 academic year, 27 states still had more residency spaces than medical students to fill them, but other states, including Florida and Texas, had too few GME training positions. Cuts to Medicare GME funding could also hamper family-medicine residency programs on a national level.
"Given enrollment growth, it may soon be impossible for all graduates of U.S. medical and osteopathic colleges to secure GME slots unless there is a sizable increase in the number of training positions," Iglehart writes. "The absence of health-workforce planning, a hallmark of the free-wheeling U.S. market economy, may come back to haunt policymakers, particularly when physician shortages become more apparent as the ACA's coverage expansion takes hold."
Full Text (http://www.nejm.org/doi/full/10.1056/NEJMp1306445?query=featured_home )