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A July 29 report by the Institute of Medicine on reforming the nation’s graduate medical education program has struck a nerve with the AUA and other medical societies by questioning the seriousness of continuing physician shortages in the United States.
Washington-A July 29 report by the Institute of Medicine (IOM) on reforming the nation’s graduate medical education (GME) program has struck a nerve with the AUA and other medical societies by questioning the seriousness of continuing physician shortages in the United States.
While the AUA “applauds” IOM for studying the governance, finance, and regulation of GME in the U.S., Christopher M. Gonzalez, MD, MBA, the AUA’s Public Policy Council vice chair, expressed serious concern with the 205-page document’s conclusion that there is no credible evidence to support claims of a looming physician shortage.
In its report, “Graduate Medical Education that Meets the Nation’s Health Needs,” the IOM said that the underlying methodologies and assumptions about the future physician work force in various studies that predict serious shortages “are problematic.”
“They generally assume historical provider-patient ratios using existing technological supports and thus have limited relevance to future health care delivery systems or to the need for a more coordinated, affordable, and patient-centered health care system,” the report said.
“Physician work force analyses that consider the potential impact of changes and improvements in health care delivery draw different conclusions,” it added. “These studies suggest that an expanded primary care role for physician assistants and advanced practice registered nurses, redesign of care delivery, and the use of other innovations, such as telehealth and electronic communication, may ultimately lessen the demand for physicians despite the added pressures of the aging population and coverage expansions.”
Noting that some are pushing for significant increases in Medicare GME funding by increasing the cap on Medicare-funded residency positions to increase the number of physicians, IOM said evidence suggests that producing more physicians is not dependent on more money for GME. Nor would increasing the number of physicians resolve work force shortages in areas of the country where shortages are most acute or in all specialties and care settings, IOM added.
The AUA and other members of the Surgical Coalition take issue with that assessment and are calling for passage of legislation in Congress that is directly aimed at resolving physician shortages in both specialty and primary care. In addition, the AUA expressed concern about IOM recommendations to establish a single funding stream.
“Such consolidation may negatively impact teaching hospitals in their mission to take care of our sickest patients and to safely train medical residents,” said Dr. Gonzalez. “We are also concerned about the recommendation to create a new Department of Health and Human Services (HHS) GME policy council and a GME Center within the Centers for Medicare & Medicaid Services, which runs the risk of merely creating bureaucracies and delaying the training of new physicians needed to care for the growing patient population.”
Dr. Gonzalez said the AUA believes GME funding should be boosted equally to support increased GME slots for both specialty and general practice medicine. He noted that the American Association of Medical Colleges has estimated a deficit of 130,000 physicians equally in primary and non-primary care by the year 2025, with 20% of the U.S. population reaching the age of 65 by 2030.
To meet these population demands, the HHS projects a need for 14,000 urologists by 2015 and 16,000 by 2020. Currently, there are fewer than 10,000 urologists practicing in the U.S., with an average age of 52.5 years. Forty-four percent of the urology work force is over the age of 55, with 18% age 65 or older and 7.4% over the age of 70.
A recent AUA Workforce and Compensation Survey indicated that up to 20% of currently practicing urologists plan to retire in the next 5 to 10 years, while an independent analysis indicates that by 2030, urology will face a 32% shortage in the number of providers needed to care for a projected 364 million U.S. citizens.
Thus, Dr. Gonzalez urged AUA members to contact their legislators and ask them to co-sponsor the Resident Physician Shortage Reduction Act (H.R. 1180/S. 577) introduced by Reps. Joseph Crowley (D-NY) and Michael Grimm (R-NY), and by Sens. Bill Nelson (D-FL), Harry Reid (D-NV), and Charles Schumer (D-NY). In addition, he urged support of the Training Tomorrow’s Doctors Today Act (H.R. 1201) introduced by Reps. Aaron Schock (R-IL) and Allyson Schwartz (D-PA).
Both bills would provide the reforms needed to improve GME and help preserve access to specialty care by increasing the number of GME residency slots by 15,000 over the next 5 years, said Dr. Gonzalez, directing half to training in shortage specialties, such as urology; specifying priorities for distributing the new slots, such as in states with new medical schools; and studying the needs of the U.S. health care system to allocate residencies accordingly.
“We want to put a push on these bills and stimulate members to talk to their lawmakers and help us get some movement on them,” Dr. Gonzalez said. “We urge members to address their lawmakers now. Reach out to them. Give them a phone call, email, something. Call the AUA-we would be more than happy to help.”UT
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