Based on a partnership with Urology Times, articles from the American Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or [email protected] for more information.
Additional public funding for graduate medical education (GME) is a key component of any solution to the escalating health care work force crisis. Delegating responsibilities to nonphysician providers and telemedicine can only get us so far. Electronic health records have created more headaches than efficiencies. Augmented intelligence is slowly entering the picture but remains decades away from widespread adoption.
Unfortunately, the biggest source of public dollars remains frozen in time. Medicare's GME formula hasn't changed since 1997. Changes in the distribution of our population haven't been accounted for in this program, thus creating an unequal allocation of residency positions across the country. Over the years, federal policymakers nipped at the edges of the funding problem via discretionary appropriations to other agencies (eg, Health Resources & Services Administration, Veterans Health Administration, Department of Defense). State governments, too, have increased support of graduate medical education, but a few dozen slots here and there will not train a sufficient number of doctors to keep up with retirements and the health care needs of aging baby boomers.
A bipartisan bill garnering widespread support, including from the AACU, would finally break the logjam. The Resident Physician Shortage Reduction Act of 2019 (H.R.1763 / S.348) proposes to increase the number of residency positions eligible for Medicare support by 15,000 slots. Key provisions of the legislation require that at least 50% of the new GME positions are used for a shortage specialty residency program and grants top priority to hospitals in states with new medical schools. More than 100 members of the House signed on to the bill and there is an ongoing push for additional co-sponsors.
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In announcing co-sponsorship of the Senate version, Minority Leader Chuck Schumer (D-NY) insisted that the bill tackles the problem head-on by "…prioritizing those slots for communities [and specialties] that need them most. I'll fight tooth and nail to see that this critical legislation passes the Senate and is signed into law..." With or without Sen. Schumer's strenuous effort, few observers expect the bill to garner serious attention. An analytics engine estimates either version has about a 3% chance of becoming law.
Less substantive attempts to address the crisis abound at both the federal and state levels, from tweaking the total number of publicly funded positions to forgiving medical school debt. In Congress, Reps. Ron Kind (D-WI) and Mike Gallagher (R-WI) introduced the Advancing Medical Resident Training in Community Hospitals Act of 2019 (H.R.3425) to fix a technical problem in the Medicare program that limits the number of residencies in rural areas and expands opportunities to bring more doctors to community hospitals. Tim Size, executive director of the Rural Wisconsin Health Cooperative, explained in the sponsors’ press release: “Graduate Medical Education needs to be forward looking, not hampered by well-intentioned efforts of the past. To train the next generation of physicians we need as much capacity as possible.”
This bill is slowly progressing through the legislative process, having been unanimously passed by the House Ways and Means Committee in late June.