Med schools expanding, residencies are not

The nation’s medical schools are on track to increase enrollment by 30 percent in 2016 compared with 2005, a goal called for by the Association of American Medical Colleges (AAMC). However, association president Darrell Kirch noted, “This won’t amount to a single new doctor in practice without an expansion of residency positions.”

In 2013, the number of first-year medical students exceeded 20,000 for the first time.

Despite the fact that most physicians said they would not recommend the profession to their children, applicants flooded medical school admissions offices in record numbers in 2012, according to the AAMC. The applicant pool has grown nearly every year for the past decade.

However, the number of residency positions has not expanded and, in fact, may contract because of decreases in GME funding.

The battle is on to defend and expand the nation’s GME slots. Teaching hospitals quadrupled their lobbying budget in 2011, to $2.8 million, according to the Center for Responsive Politics. They are pushing legislation that would add 3,000 residencies annually through 2017. The price tag: $9 billion.

Nearly half of medical school deans expressed “major concern” about nationwide enrollment growing faster than graduate medical education, and 33 percent reported it as a “major concern” in their state.

The other problem: Those in the pipeline will not help in dealing with the 2014 wave of new patients.

With at least 12 new schools opening and existing ones growing, enrollment is expected to create 5,000 more graduates a year by 2019.

Medicare-funded GME spots essentially have remained frozen since the Balanced Budget Act of 1997.

There currently are more residency openings than U.S. allopathic medical school graduates. The gap traditionally has been filled by graduates of U.S. osteopathic schools and foreign medical schools.

At the current expansion rate, graduates from U.S. medical and osteopathic schools alone will exceed the number of expected residencies by the end of the decade, according to AAMC. The U.S. is expected to graduate more than 27,000 medical students in 2020, which is 50 percent more than in 2000. If residency programs had not been capped in 1997 and GME slots had been allowed to grow at their historical rate, there would be no physician shortage today.

Residency applicants from foreign schools are likely to be squeezed out. Graduates of foreign medical schools now make up more than 25 percent of the U.S. physician workforce—and about half of primary-care doctors—because U.S. graduates gravitate toward specialties that are more lucrative. Foreign doctors also make up a disproportionate share of those in rural communities and public clinics, and they treat a higher share of minority patients.

Despite this, there have been multiple proposals to slash GME funding because of ongoing federal budget deficit-reduction efforts. GME reductions as high as 50 percent have been recommended by the Medicare Payment Advisory Commission and the National Commission on Fiscal Responsibility and Reform, as well as President Obama’s 2013 budget proposal.

The AAMC estimated in 2011 that a 50 percent reduction in Medicare GME funding would result in the closing of 2,551 residency and fellowship programs and the loss of 33,023 GME positions.

About 9 out of 10 allopathic and osteopathic medicine graduates had educational debt in 2011. The average debt is $205,674 for osteopathic students and $162,000 for allopathic students.

A medical school graduate with $162,000 of debt would have monthly payments ranging from $1,500 to $2,100 after residency training, depending on the repayment plan, according to the AAMC.