Federal Issues - Primary Care Physician Shortage

Innovation is Key to Success in Alleviating U.S. Physician Workforce Shortage

Stephen C. Shannon, DO, MPH

As Congress debates various approaches to deal with the federal deficit and the fiscal year (FY) 2014 budget, AACOM continues to aggressively advocate for the investment in and preservation of Medicare-funded graduate medical education (GME) as well as support for other critical and innovative GME programs, such as the Health Resources and Services Administration’s (HRSA) Teaching Health Center (THC) GME Program. This innovative program not only meets a critical need, it provides a common-sense approach to supporting an increased number of primary care medical residents in underserved communities.

Inventive programs such as HRSA’s THCGME Program, currently in its third year, increase opportunities for primary care GME, set a strong precedent to fund GME outside of the traditional Centers for Medicare & Medicaid Services funding stream, and create new avenues for training medical residents in community-based, non-hospital settings. Thirty-two THCGME Programs are operating around the country, providing residency training in dentistry, family medicine, internal medicine, obstetrics and gynecology, pediatrics, and psychiatry. Out of the 32 programs, 21 are osteopathic programs or dually-accredited (DO/MD) programs. Clearly, this innovative approach has struck a chord with osteopathic medical education. I believe the THCGME Program could become a foundational program for primary care osteopathic medical education if this program continues to develop through future investments.

This fall, THCs will begin recruitment for the next class of residents that will graduate in June 2017. However, the THCGME Program has not been reauthorized beyond FY 2015. As a result, THCs do not have the guarantee of federal support for the third and final year for their next class. Sustainability of this program’s funding is absolutely necessary to adequately demonstrate its effectiveness. The continuation and further expansion of this program is critical to addressing physician workforce needs and access to patient care. This program must now be extended to avoid disruptions for new medical residents. Unless Congress acts to maintain this program and its funding, the medical residents currently being trained and the patients being served by those residents face an uncertain future. An innovative program designed to address the type of physician training needed in this country could be brought to an abrupt halt—and the populations encountering the greatest lack of access to care may be deprived of the care they need.

Of course, GME continues to be a target during the federal deficit negotiations with both Congress and the Administration (see AACOM’s statement) calling for funding cuts, threatening the stability and continuity of both the nation’s residency training programs that produce future physicians and the hospitals that provide care to Americans. This country continues to face a serious physician workforce shortage that will worsen as millions of new U.S. citizens enter the health care system with the implementation of the Affordable Care Act. The nation’s policymakers should be prepared to ensure that these new patients are provided with the health care they will need.

As Congress continues its difficult work to find balanced approaches to reduce the federal deficit and bring the country toward sound fiscal footing, it has become critical that policymakers develop unique and innovative approaches to invest in the nation’s medical residency training programs. This would help to ensure a sufficiently trained physician workforce and to build upon the training models currently put place nation's osteopathic medical schools. Investing in funding and new approaches to training future physicians will only serve to increase patient access to health care, lower costs, and ensure the presence of the health professions workforce needed in our evolving health care system.

U.S. Capitol