Ensuring an Adequate Specialty Physician Workforce for the 21st Century

On the third Friday of every March, medical school students find out into which residency training program they have been selected.  That day is popularly known as “Match Day” and marks an important date in one’s pursuit to become a doctor.

As each resident opens his or her envelope to reveal their “Match” they do so with the knowledge that the country faces a severe physician workforce shortage — one that will only worsen as health insurance coverage expands to millions of Americans and the baby boomers continue to reach retirement age. By the year 2025, the United States will face a shortage of between 46,000 to 90,000 physicians, a shortfall of roughly of 12,000 to 31,000 primary care physicians and 28,000 to 63,000 specialists according to a 2015 study conducted by the Association of American Medical Colleges (AAMC).   An inadequate number of physicians is already having consequences that jeopardize patient access to specialty care, including:

• Demand for services is increasing — particularly in the fields of cardiology, urology, dermatology, endocrinology, ophthalmology, gastroenterology and neurosurgery — outpacing demand for adult primary care services. As a result, patients are experiencing considerable wait times for care.

• The maldistribution rate among physicians, especially in rural communities, is significant, and in many parts of the country, Americans have limited access to specialty health care.

• Physicians are getting older, and nearly forty percent of the current workforce is over the age of 55. Depending on the specialty, it can take up to 18 years — including medical school, residency and fellowship — to train a specialty physician, and once gone from the workforce, they are not easily replaced.

The magnitude of the projected physician workforce shortage speaks to the need to expand the number of residency training slots. Although the number of medical students being trained in the U.S. is increasing due to the opening of new medical schools and expanding the class size of existing schools, no corresponding increase in the number of Medicare-funded residency training slots has occurred.

This is because more than a decade ago the Balanced Budget Act of 1997 capped graduate medical education (GME) funding. This cap is highly problematic because it is not the number of medical students trained, but rather the number of positions in the GME system that determines the supply of physicians. In recognition of the need to increase the size of the physician workforce and the time it takes for a resident to finish training, it is essential that we approach this problem with a sense of urgency.

To address the growing physician workforce shortage and ensure a physician workforce that is of sufficient size and specialty mix, the Alliance of Specialty Medicine is calling on Congress to pass legislation to eliminate the current GME funding restrictions. To further this objective, the Alliance has endorsed the Resident Physician Shortage Reduction Act (H.R. 2124/S. 1148), and the Training Tomorrow’s Doctors Today Act (H.R. 4774).  Both of these bills will increase the number of Medicare-supported residency slots by 15,000 over a five-year period, have bipartisan support and would go a long way towards addressing this looming physician workforce crisis.

An appropriate supply of well‐educated and trained physicians is essential to ensure timely access to quality health care services for all Americans.  America’s specialty physicians challenge Congress to meet these needs by adopting legislation to increase the number of Medicare-supported residency positions.

Hunt Batjer, MD, Alliance of Specialty Medicine

Hunt Batjer is the chairman of the University of Texas-Southwestern’s Department of Neurological Surgery. He is a president of the American Association of Neurological Surgeons and past chair of both the Residency Review Committee for Neurological Surgery and American Board of Neurological Surgeons.