The medical training system is in crisis. By 2034, the American Association of Medical Colleges (AAMC) predicts a shortage of 37,800 to 124,000 physicians in primary and specialty care. This shortage is particularly pronounced in rural areas and communities serving marginalized populations.
With the stress of a growing population and increasing numbers of doctors retiring, steps must be taken to secure the future of American health care. We call on members of the United States House and Senate to pass the Increasing Competition for Medical Residency Act (HR 8131), which would repeal the antitrust exemption granted to the residency matching process for graduates medical schools and allow for other certification routes.
The current policy is like placing a bandage over a bleeding artery. All medical school graduates must obtain a residency position to eventually practice medicine in their chosen specialty. However, there are not enough residency positions to keep up with the number of graduates.
Congress attempted to add resident physicians to approximately 2,000 positions per year from 2023 to 2029 through the Resident Physician Shortage Reduction Act; however, this increase is far from sufficient to remedy the dramatic shortage of doctors.
In 2022 alone, thousands of graduating American medical students were unmatched through the National Resident Matching Program (NRMP) matching system, effectively preventing them from practicing medicine unless they can find a vacancy, move to another specialty or reapply the following year. In addition to American medical students, there are currently approximately 3,000 international medical graduates who are not practicing due to their inability to obtain residency through the buddy system. In both cases, the buddy system emerges as a target for change, as it plays an important role in preventing qualified medical graduates from practicing medicine independently. In a world reeling from the aftermath of a pandemic, this cannot last.
So what stands in the way of changing the policies surrounding the correspondence system? Based on legislation from nearly 20 years ago, the matching system is immune from lawsuits on antitrust grounds. In 2002, Jung v AAMC alleged that the AAMC, NRMP, and many large academic institutions violated antitrust laws by “unlawfully restricting competition in the marketplace for medical resident services”, removing residents’ ability to bargain their salary and forcing them to participate in specific schemes and programs. Locations. The lawsuit ended when Congress passed legislation in the Independent Pension Funding Fairness Act of 2004 that these organizations were exempt from antitrust law because of the unique nature of medical education. .
Antitrust law prevents market monopolies and the stifling of competition, which is precisely the control the correspondence system exerts over medical graduates. The introduction of HR 8131 is not intended to abolish the correspondence system, but rather to repeal the AAMC and NRMP’s exemption from federal antitrust laws, requiring them to follow the same set of laws as other institutions in their jurisdiction. ilk and potentially allowing for alternative certification pathways.
There is little current legislation defining the specific practices that the NRMP and AAMC must follow. Rather, these organizations are responsible for passing their own laws that apply to the stakeholders who benefit from their services. Examples of stakeholders in this group include medical students, residents, medical schools and residency programs. Additionally, the AAMC often supports and makes recommendations on relevant pieces of legislation, as evidenced by its endorsement of the Resident Physician Shortage Act and legislation to protect 340B hospitals.
As things stand, alternatives to traditional certification are limited. Yet they exist. To combat the growing shortage of physicians and its disproportionate impact on rural areas, Missouri established the Physician Assistant Program in 2014 to provide unparalleled medical graduates the opportunity to practice medicine as physician assistants under the supervision of licensed physicians. After three years of supervised practice, physician assistants become eligible to enter a traditional residency program.
Although this initiative generated some controversy due to its unconventional approach, it also laid the groundwork for change. This program inspired the creation of Missouri House Bill 550, which would allow physician assistants in Missouri to apply for full licensure after five years of supervised practice. Although the bill itself is promising, it died during committee discussions in 2021. Several provisions have been split into separate bills that are not currently listed for discussion on the House calendar, indicating their relative lack of priority despite the ever-increasing need for a solution. .
Signing HR 8131 into law may be the missing piece needed to revitalize this legislation not only in Missouri, but in other states as well. After the removal of the special antitrust exemption from the matching program, the exploration of alternative certification routes is moving from theory to practice. Stakeholders will realize the need to enable all medical school graduates to practice medicine, opening the door to new opportunities to alleviate the doctor shortage crisis.
This parallel implementation path would not be without its challenges. After all, the buddy system is a process that has dictated the flow and progression from medical students to residents for over 70 years. Namely, programs should be built from the ground up while simultaneously providing adequate training for residents. This could lead to alternative certification pathways being viewed as inferior or uncompetitive, with the mixed results of not attracting qualified candidates who do not want their education to be perceived as inferior or diluting the quality of certification professionals. health by training those who are genuinely unfit to practice.
However, it is important to realize that the challenges that may accompany the elimination of the antitrust exemption are not sufficient to oppose its repeal. Given the absence of significant reforms to the AAMC/NRMP in recent years, the system is ripe for an overhaul. We have many skilled health professionals sitting on the sidelines being funneled through a ossified and overburdened system. The time for change has come.
Aamir Hussain is a resident physician practicing in Washington, D.C. Umayr Shaikh, a medical student at Georgetown University, helped create this story.
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