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Reviews | A Federally Funded Physician Shortage Remedy

Much has changed in healthcare since the 1990s: HIV infection is no longer a presumed death sentence, minimally invasive and robotic techniques have redefined a variety of surgeries, and telemedicine has greatly expanded access to care. Why then, in the face of such remarkable progress and change, has the number of doctors the United States produces each year not changed enough to meet the changing needs of our population? The answer is Congress.

To become fully licensed physicians, there is only one path for medical students to follow: residency. With the vast majority of residency programs subsisting on federal funds, about 82% in 2018, the federal budget has a direct and chilling limiting effect on the number of physicians the United States produces. This federal bottleneck is largely the result of the 1997 Balanced Budget Act, which capped the number of federally funded residency spaces at 100,000. Since then, the only increase has been the 2021 plan to add just 1,000 residency spaces (phased over 5 years). In context, this represents a 1% increase in 24 years. At the same time, the US population has increased by 22% and, according to the Association of American Medical Colleges (AAMC), the number of medical students has increased by 37.5% since 2002. According to the figures, the shortage is not the result of a lack of needy students or medical students, but rather of a shortage of federally funded residency spaces.

For the average American patient, this represents another barrier to obtaining much-needed health services. The simple fact is that there is no health care without doctors. Fewer doctors per person means fewer patients who can receive care, or less time per patient.

While the need for physicians of certain specialties or in specific regions may vary, the United States as a whole is in the midst of a physician shortage that is just beginning. An AAMC report predicted a terrifying shortage of 37,800 to 124,000 physicians by 2034. With more than two in five American physicians reaching age 65 or older in the next decade, an aging and growing Medicare population needing ever more specialized care, a young population increasingly in need of mental health services and a general increase in the total population, we cannot ignore the growing demand for doctors.

The COVID-19 pandemic in particular has highlighted the importance of doctors and other healthcare workers like never before, and the increasing burden placed on them. Hospitals across the country have been overwhelmed and understaffed in various waves over the past few years. According to a publication from the Mayo Clinic, 62.8% of doctors experienced one or more manifestations of burnout in 2021, compared to 38.2% in 2020, and during the same period, doctors reported an increase in depression and decreased satisfaction with work-life balance. The specific challenges of the pandemic may be unique, but this test of our courage is only a taste of the real crisis to come.

This predicament also raises the question: why has so little changed in more than two decades? The answer is complex. The prevailing sentiment in Congress in 1997 was that a failure to limit the number of residency spaces would produce an oversupply of physicians and too high a bill for the Medicare budget. But the current reality of health care is markedly different. Despite this, lingering budget concerns, lack of widespread congressional support, and lack of public awareness of the issue have all played a prominent role in impeding progress. With less than 10% of proposed bills passing in the last session of Congress (2019-2021) and healthcare spending focused on COVID-19 related research, testing and economic relief, there is no It’s no surprise that the sweeping residency-funding changes have been difficult.

However, this lack of progress in funding does not mean that no effort has been made. Behind the scenes, former Sen. Bill Nelson (D-Fla.), former Rep. Joseph Crowley (DN.Y.) and several others have repeatedly tried to pass legislation that would further increase the residency cap . Amazingly, eight previous iterations of their bills have been proposed and defeated between 2007 and 2019. The latest iteration, introduced in March 2021 and sponsored by Sen. Robert Menendez (DN.J.), is known as Resident Physician Shortage Reduction Act of 2021. and seeks to increase federally funded residency spaces by 14,000 over 7 years. A growth of 14,000 places is probably too small to be a panacea for the shortage of doctors, but the passage of this bill would represent an important first step. Adding even more residency positions or removing the residency cap entirely would ultimately have a greater impact, but legislative progress is often incremental.

Failure to pass meaningful legislation may paint a rather grim picture at first glance, but the COVID-19 pandemic, the reversal of Roe vs. Wade, and now a resurgence of respiratory syncytial virus (RSV) in children have undoubtedly propelled health care into the public spotlight. I believe the public understands the enormous value of physicians, and with incremental progress on this issue — between adding 1,000 residency spaces and proposed legislation for more — Congress might be ready to finally invoke meaningful change. . Without it, we risk failing to correct a growing crisis of our own making: an epidemic of doctor shortages.

Christian Hardoy is a sophomore medical student at UC Irvine School of Medicine, with an interest in health policy and an active involvement in medical education research, student mentorship, anemia research, and geriatrics. .

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