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A Word From the President: Why Preserving GME Is Critical to America’s Health

AAMC Reporter March 2013

Last month, we watched a game of political brinksmanship between congressional lawmakers and President Obama. Ultimately, they could not strike a deal and each party blamed the other for allowing $85 billion in cuts—called sequestration—to take effect on March 1.

Unless Congress passes legislation to mitigate these cuts, sequestration’s across-the-board reductions will have a profoundly negative impact on many programs vital to medical schools and teaching hospitals and our ability to care for patients. In addition to its disastrous implications for medical research, sequestration also reduces federal support for graduate medical education (GME). As I noted in an opinion editorial published last month in the Capitol Hill newspaper The Hill, “With our nation facing a serious shortage of physicians over the next decade, cuts to graduate medical education will mean that patients in the future may not be able to see a doctor when they need one.”

An unprecedented confluence of factors makes our work to ensure federal funding for GME critical. The nation faces a shortage of 91,500 physicians by 2020, according to the AAMC Center for Workforce Studies. This comes at a time when approximately 10,000 Americans turn 65 daily and will continue to do so for the next two decades—and we all know older patients require more care. In addition, now that the Supreme Court has upheld the Affordable Care Act (ACA), 32 million more Americans will gain insurance coverage beginning next year. The lessons from Massachusetts’ health care reform tell us that people are more likely to use health care services when they are insured, increasing physician demand.

At the same time, the U.S. population is growing while becoming increasingly diverse. The U.S. Census Bureau projects that we are on track to be a “majority minority” nation by 2050 or sooner, making the need for culturally competent physicians more important than ever. A recent opinion piece co-written by former Senate Majority Leader Tom Daschle in Politico lays out the shameful disparities in care that we must confront as a nation. These disparities have revealed that certain minority populations will require more care to achieve health status equal to that of whites, which will further compound the looming physician shortage.

The AAMC Board of Directors reinforced our commitment to lead on GME advocacy and last year approved several policy recommendations that we believe are critical to stemming the impending doctor shortage. (You can view the entire AAMC Physician Workforce Policy Recommendations at

First, the number of federally supported GME training positions should be increased by at least 4,000 a year. This action would increase the expected supply of doctors by approximately 30,000 by the end of the decade—meeting approximately one-third of the expected shortage. The increase would represent an expansion of approximately 15 percent over current training levels and would provide a sufficient number of GME positions to accommodate U.S.-educated doctors while allowing for international medical graduates to occupy about 10 percent of training positions.

Second, current and future funding for new residency positions should be planned with clear attention to population growth, regional and state-specific needs, and evolving changes in delivery systems. The AAMC estimates that half of the projected shortage of 91,500 physicians is expected to be in specialty care. As such, our policy statement calls for approximately half (2,000) of the additional positions to be targeted to primary care and generalist disciplines, with the remainder distributed across the approximately 140 other specialties upon which an aging nation relies. This makes intuitive sense when you consider that Americans are living longer and with more chronic conditions.

Third, the workforce statement recommends that policymakers leverage clinical reimbursement and other mechanisms to affect geographic distribution of physicians and influence specialty composition. While the ACA took important steps to increase reimbursement to primary care providers, we must find ways to provide economic rewards to physicians who serve geographically or economically underserved communities. Education and training simply cannot overcome the market incentives that influence physician specialty choices. Recent studies show 31 percent of physicians are not accepting new Medicaid patients. Since teaching hospitals and physician faculty are more likely to serve poor and vulnerable populations, they will be asked to see more patients for whom reimbursement is less than the cost of providing care. Physicians and other providers must be paid adequately to ensure that patients have access to care.

Finally, we call on the federal government to continue to invest in delivery system research and evidence based innovations in health care delivery. Increasing federal support for physician training by 15 percent is not enough to ensure appropriate access to care. Delivery system innovations that improve efficiency, integrate care, and leverage other health professionals also will be necessary, and this cannot be achieved without supporting what NIH Director Francis Collins, M.D., Ph.D., calls “the science of health care delivery.” Ultimately, an adequate supply of physicians must be achieved through more efficient health care delivery models, as well as by increasing physician training positions. No single approach will be sufficient.

While the AAMC supports a balanced approach to reducing the nation’s deficit, we also believe that our nation must make the investments necessary to ensure there are enough physicians to provide Americans with access to high-quality health care. We cannot afford to wait to make these investments because by the time the physician shortage becomes a reality, it will be too late. As a provocative new AAMC advertisement—endorsed by more than 45 physician groups—asks, “If there is no doctor, what will you do?” The time to act is now.

Darrell G. Kirch, M.D.

AAMC President and CEO