Report: Overhaul of Physician Training Needed as Doctor Shortage Looms

More than $15 billion is spent annually on physician training in the US, but, according to a new report, more intense supervision is needed when it comes to training the next generation of doctors.

Already, the medical centers that provide physician education have taken issue with the report, which calls for per-resident funding that would be based on outcomes that will address the most important needs in healthcare at this time. Marie French, writing for Bloomberg, says that an example of that would be the need for more family doctors in some areas.

The report by the Institute of Medicine (IOM), Graduate Medical Education That Meets the Nation's Health Needs, contains recommendations on how to improve the graduate medical education (GME) system. The Surgical Coalition, which represents more than 20 professional societies and about 250,000 surgeons and anesthesiologists in the US, is appreciative of the report which took two years to complete.

As health insurance coverage is growing to cover millions of Americans, and baby boomers continue to reach retirement age, there is the possibility of a severe shortage of physicians.

By the year 2025, there will be a shortage of about 130,600 physicians, 64,800 specialists, and 65,800 primary care physicians. The decrease will result in a shortage of surgical care, which includes:

• Long wait times for surgery because of the increase demands for surgical services.

• The fact that surgeons are not evenly dispersed across the nation, particularly in rural communities. In many parts of the country there is a shortage, or, in some cases, no general surgeons, orthopedic surgeons, or neurosurgeons.

• Twenty-five percent of US citizens do not live within 60 minutes of a Level I adult trauma center. A larger number do not have a Level I or II children's trauma center nearby.

• Aging surgeons, and the fact that 40% of surgeons are older than 55, are making a dent in the number of practicing surgeons. Considering that it takes 13 years to train a surgeon, when a surgeon is gone from the workforce, he is not easily replaced.

The Surgical Coalition is committed to helping with this problem. Congress can help by lifting the cap on the number of federally supported residency training positions and creating legislation to increase the number of Medicare-supported residency positions.

The report calls for a 10-year introduction period during which the practices of basing residency payments on historical caps and the Medicare services provided, would end. A move like this would have to be approved by Congress, which provides two-thirds of the $15 billion in public training money through the funding of Medicare.

The Association of American Medical Colleges (AAMC), says Julie Rovner of Kaiser Health News, opposes this recommendation because it would take away federal dollars from Medicare patients.

"We are not taking money out of the system," said Gail Wilensky, a co-chairwoman of the institute panel that wrote the report. "But we think current expenditures, because of the lack of transparency and accountability, are difficult to justify."

The AAMC also says that proposing a 35% cut in payments to teaching hospitals will diminish funding for vital care and services available at:

• teaching hospitals

• Level I trauma centers

• pediatric intensive care units

• burn centers

• access to clinical trials

In a description of the publication in The National Academies (Advisers to the Nation on Science, Engineering, and Medicine), the report is called a focus on the extent to which the current system supports or does not support producing a physician workforce that is prepared to provide the best patient-centered and affordable health care. It also points out the manner in which the leverage of federal funding can be used toward these goals.

The report's recommendations aim to produce better physicians, innovate graduate programs, produce transparency and accountability in programs, and strong planning and oversight of the use of public funding to support physician training.

08 1, 2014
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