Many experts believe the United States is facing a doctor shortage in the not-too-distant future. Lorraine Rapp and Linda Lowen, hosts of WRVO's health and wellness show “Take Care,” recently spoke with Dr. Atul Grover, the chief public policy officer of the Association of American Medical Colleges about why there may not be enough physicians and what could be done about it.
Lorraine Rapp: Medical school applications seem to be steady, and at different times even rising. How do we explain a doctor shortage?
Dr. Grover: Well, I think the most difficult thing for most people to understand that haven’t gone through the medical education process is that when we graduate with an MD, we’re not really ready to go out and practice medicine. So every physician has to go through at least three years of training before they can become certified in a specialty. In some cases, for me that was three years, but if you’re going into neurosurgery, it might be seven or eight years. So the real bottleneck is we have plenty of bright young students interested in a career in medicine, and we’ve made more space for them in U.S. medical schools, but we haven’t grown the number of residency training programs that all doctors need before they go out and practice.
Lorraine Rapp: Is that a change? Is that something new?
Dr. Grover: Well, it’s about 16 years old that we’ve had this problem. And it started back in 1997 with the Balanced Budget Act that Congress passed. And one of the things that Congress did was, historically, Medicare would pay for its share of the costs of training physicians since we take care of a lot of Medicare patients in our teaching hospitals and in our medical school faculty plans. But, in 1997, Congress said, “We’re not going to pay our share of training anymore physicians that are training right now.”
Linda Lowen: So when you describe this bottleneck, are you saying then that there are medical school students— they’ve completed the program but they can’t get into residency programs, or so there aren’t enough available—what happens to those potential residents, are they just waiting?
Dr. Grover: Well, as of today, there are theoretically enough residency positions to accommodate all the current graduates of U.S. medical schools. However, because we have tried to respond to the physician shortage by opening up the beginning of that pipeline, we project that by the end of the decade, we may have more physicians graduating from medical school than we have first year residency positions for.
Linda Lowen: So there’s a fix on one end, but it doesn’t follow through on the other?
Dr. Grover: Exactly, and the challenge is, even if Congress were to lift that cap on the training of physicians tomorrow, we need a little time to ramp up those programs.
Lorraine Rapp: What do you think are the essential things that will really make a difference overall? What would you do if you could change anything?
Dr. Grover: I think the essential things to address the shortage right now would be some things we’re already doing—like try to figure out new models of care, trying to train our health professionals in teams and make better use of those teams as we’re doing in medical education today. But we also need to make sure that we train more physicians. And so, if I were a member of Congress, or the Speaker of the House, I would take up a bill that would allow Medicare to resume paying its fair share of the cost of training physicians that over 100 members of Congress have already gotten behind and said “we need to pass.”
More of this interview can be heard on "Take Care," WRVO's health and wellness show Sunday at 6:30 p.m. Support for this story comes from the Health Foundation for Western and Central New York.