WSJ: Medical Schools Can't Keep Up
Tuesday, April 13, 2010 at 11:37AM Those lying Democrats have been caught in yet another doozy. They claimed there would be no doctor shortages or rationed care from the new health care bill, even though anyone with a hint of common sense knew better. Well, it took less than one month from the date that Obama signed the bill into law for the Association of American Medical Colleges to cry foul on the Democrats bogus claim. This from the Wall Street Journal:
As Ranks of Insured Expand, Nation Faces Shortage of 150,000 Doctors in 15 Years
The new federal health-care law has raised the stakes for hospitals and schools already scrambling to train more doctors.
Experts warn there won't be enough doctors to treat the millions of people newly insured under the law. At current graduation and training rates, the nation could face a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges.
That shortfall is predicted despite a push by teaching hospitals and medical schools to boost the number of U.S. doctors, which now totals about 954,000.
The greatest demand will be for primary-care physicians. These general practitioners, internists, family physicians and pediatricians will have a larger role under the new law, coordinating care for each patient.
The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020. But the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007.
A shortage of primary-care and other physicians could mean more-limited access to health care and longer wait times for patients.
Proponents of the new health-care law say it does attempt to address the physician shortage. The law offers sweeteners to encourage more people to enter medical professions, and a 10% Medicare pay boost for primary-care doctors.
Meanwhile, a number of new medical schools have opened around the country recently. As of last October, four new medical schools enrolled a total of about 190 students, and 12 medical schools raised the enrollment of first-year students by a total of 150 slots, according to the AAMC. Some 18,000 students entered U.S. medical schools in the fall of 2009, the AAMC says.
But medical colleges and hospitals warn that these efforts will hit a big bottleneck: There is a shortage of medical resident positions. The residency is the minimum three-year period when medical-school graduates train in hospitals and clinics.
There are about 110,000 resident positions in the U.S., according to the AAMC. Teaching hospitals rely heavily on Medicare funding to pay for these slots. In 1997, Congress imposed a cap on funding for medical residencies, which hospitals say has increasingly hurt their ability to expand the number of positions.
Medicare pays $9.1 billion a year to teaching hospitals, which goes toward resident salaries and direct teaching costs, as well as the higher operating costs associated with teaching hospitals, which tend to see the sickest and most costly patients.
Doctors' groups and medical schools had hoped that the new health-care law, passed in March, would increase the number of funded residency slots, but such a provision didn't make it into the final bill.
"It will probably take 10 years to even make a dent into the number of doctors that we need out there," said Atul Grover, the AAMC's chief advocacy officer.
While doctors trained in other countries could theoretically help the primary-care shortage, they hit the same bottleneck with resident slots, because they must still complete a U.S. residency in order to get a license to practice medicine independently in the U.S. In the 2010 class of residents, some 13% of slots are filled by non-U.S. citizens who completed medical school outside the U.S.
One provision in the law attempts to address residencies. Since some residency slots go unfilled each year, the law will pool the funding for unused slots and redistribute it to other institutions, with the majority of these slots going to primary-care or general-surgery residencies. The slot redistribution, in effect, will create additional residencies, because previously unfilled positions will now be used, according to the Centers for Medicare and Medicaid Services.
Some efforts by educators are focused on boosting the number of primary-care doctors. The University of Arkansas for Medical Sciences anticipates the state will need 350 more primary-care doctors in the next five years. So it raised its class size by 24 students last year, beyond the 150 previous annual admissions.
In addition, the university opened a satellite medical campus in Fayetteville to give six third-year students additional clinical-training opportunities, said Richard Wheeler, executive associate dean for academic affairs. The school asks students to commit to entering rural medicine, and the school has 73 people in the program.
"We've tried to make sure the attitude of students going into primary care has changed," said Dr. Wheeler. "To make sure primary care is a respected specialty to go into."
Montefiore Medical Center, the university hospital for Albert Einstein College of Medicine in New York, has 1,220 residency slots. Since the 1970s, Montefiore has encouraged residents to work a few days a week in community clinics in New York's Bronx borough, where about 64 Montefiore residents a year care for pregnant women, deliver children and provide vaccines. There has been a slight increase in the number of residents who ask to join the program, said Peter Selwyn, chairman of Montefiore's department of family and social medicine.
One is Justin Sanders, a 2007 graduate of the University of Vermont College of Medicine who is a second-year resident at Montefiore. In recent weeks, he has been caring for children he helped deliver. He said more doctors are needed in his area, but acknowledged that "primary-care residencies are not in the sexier end. A lot of these [specialty] fields are a lot sexier to students with high debt burdens."
Reader Comments (6)
My GP doctor is 64 and could retire. Obviously, he doesn't have too many years left to practice. But he had intended to stay another 5 years.
Last time I saw him, he commented, "In order to comply with Obamacare, one of the things I would be required to do is have ALL my records electronically scanned. I have several rooms of thick files with more in storage. To purchase the program and pay for employees to scan every piece of paper in every file would cost me $28,000. I will retire before I do that."
He also shared that right now he only recoups $275 from Medicare for a $750 procedure. Recently doctors were told to take another 21% hit on that figure.
What incentive is there for any young person to go into debt for a medical career?? Especially without tort reform.
Great post NeeNee. Very interesting insight and there is little, to no reason for a young person to go into medicine. That being the case, the government will likely begin to fully subsidize (at taxpayers expense) those who go into medicine.
Didn't Congress and Obama write in a "Doctor Fix" when they did all the back room deal making?
Here's a term that I keep hearing,
even from Benito Obama at times---the
term that something political
or some concept is "sexy."
Quote from article: " He said more doctors are needed in his area, but acknowledged that "primary-care residencies are not in the sexier end. A lot of these [specialty] fields are a lot sexier to students with high debt burdens."
CERTAIN MEDICAL FIELDS ARE "SEXY"????
Okay, now let's follow this to its logical conclusion:
certain kinds of plastic surgery could lead to
sexual appeal enhancement . . . gynecologists
spend most of their time women's sexual areas.
Somehow I don't think that's necessarily what
people who use this metaphor are referring to.
Kind of like last year's Stacy & Clinton's reaction
to a really good outfit on What Not to Wear:
"Shut up!" That one really got to me.
Obviously vocabulary is not taught as part
of English anymore!
AT this moment a lot of the liberal Democrats are having second thoughts about this Obama
Healthscare and wishing now they had read it.....My, my is that not what we were telling
these morons from the get go, sorry boys, your goose is cooked and you want be able to
talk your sorry rear ends out of this one.....
Well, the bill was about Health INSURANCE... not Health CARE. The Dems conveniently left out the math of adding millions to insurance rolls without planning anything to increase the number of doctors to support that increase. I already have to plan at least 3 months ahead for my annual... I'm guessing I'll have to schedule for the next year when I go in this year!