Health Care, Higher Education, and Human Resources

GR hospitals turning away residency applicants

Medical schools are churning out new physicians to get ahead of a projected shortage in 2020.

July 4, 2014
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GR hospitals turning away residency applicants
Payam Sadro, a family medicine resident at Mercy Health Saint Mary’s, practices placing a cast on an arm. Courtesy Mercy Health

(As seen on WZZM TV 13) With expectations of a U.S. physician shortage by 2020 and medical schools increasing the number of graduating students, West Michigan is beginning to feel the effect of supply and demand.

The 2014 Main Residency Match results were released March 21; 29,671 medical student graduates were offered first- and second-year residency positions in the United States. However, the Association of American Medical Colleges released a written statement by Dr. Darrell Kirch, president and CEO of the organization, noting the number of students who went unmatched.

“Based on our preliminary analysis of this year’s data, it appears that several hundred U.S. medical students did not match to a first-year residency training program,” said Kirch in the written statement.

“As a result, with a serious physician shortage looming closer, we remain concerned that the 17-year cap on federal support of new doctor training will impede the necessary growth in residency positions that must occur to ensure that our growing and aging population will receive the care it needs.”

According to Dr. Jeff Postlewaite, interim director of medical education at Metro Health, the graduate medical education programs at Metro have received more applicants than available spots since his tenure at the health system.

Dr. Rolland Mambourg, vice president of medical affairs at Mercy Health Saint Mary’s, said in general there had always been residency positions available at the hospital up until the last couple of years.

“Beginning two years ago, we saw for the first time what appeared to us to be excess applicants over slots,” said Mambourg. “The residents for match this year — there were beginning to be some stories of students finishing medical school who did not match in residency programs.”

The Center for Workforce Studies at the Association of American Medical Colleges published a study in 2012 on projected physician shortages for the United States. According to the report, a 2006 study for Michigan forecast a potential shortage of roughly 4,400 physicians by 2020.

Dr. Robert Satonik, assistant dean for the graduate medical education program at Central Michigan University’s College of Medicine, said the physician shortage cuts across every specialty, but is more severe in the general specialties, such as family medicine, internal medicine, pediatrics and general surgery.

“There is some recent data from this winter that says it won’t be quite as bad as they talked about, but we are pretty much at a point where, at least for the foreseeable future — until Congress does something to change the basic funding or how we pay for residencies — that we are going to be in a position where there will be far more applicants than there will be positions,” said Satonik.

The number of residency positions federally funded through Medicare was capped in the United States in 1997 through the Balanced Budget Act. Mambourg said the government’s decision to limit the number of residency positions funded at the federal level was a cost-savings effort.

The Balanced Budget Act limited the number of allopathic and osteopathic medical residents receiving Medicare reimbursement for indirect and direct graduate medical education, using the number of residents in hospitals as of Dec. 31, 1996.

“You see the conflict here: On the one side, we are saying we don’t have enough physicians, and on the second side, we have the feds step in and say, ‘You know, we have to control costs,’” said Mambourg.

“At the other side, we have students who have put all that money into being trained and we are not going to let them finish their medical education training,” he added.

Joe Gavan, managing partner at Impact Professionals LLC and consultant at Mary Free Bed Rehabilitation Hospital, said due to the expectation that one-third of current physicians will retire in the next 10 years, and due to health care reform increasing insured individuals by 32 million, plus a growing population, the demand for doctors is swelling.

“The major issue is just that there are too few residencies for the amount of medical students that are being churned out, and the medical schools are stepping it up because they know there is going to be a huge demand for extra doctors,” said Gavan. “The government froze the residency funding back in 1996, 1997, and it has just stayed flat since then, with a few exceptions.”

He said due to the cap on federal underwriting for residency positions, the system can’t keep pace with the number of students, who have to finish a residency program in order to practice.

“It has to be corrected, but it is going to take an act of Congress to correct it,” said Gavan. “Congress has to say, ‘We are going to open up more funding,’ or they have to insist that hospitals pay for it themselves — but a typical residency costs a hospital roughly $105,000 or $100,000 per year, per resident.”

The AAMC reported medical schools and teaching hospitals have addressed the anticipated physician shortage by increasing enrollment size and voluntarily underwriting new residency training programs, which equates to a total cost of $1 billion each year for the past decade.

The ability for a hospital to self-fund residency programs depends on the extent of the organization’s operating margin and community needs, Gavan said.

“They would have to be willing to put in the $110,000 or so per year, per resident, and they would have to find a good reason to do it,” said Gavan. “A smaller operation like Mary Free Bed — it would be very difficult to do that without the government’s support.”

Due to its recent affiliation with MSU’s College of Human Medicine, Mary Free Bed is exploring the potential of a residency program at the rehabilitation hospital. Gavan said the new program would focus on physical medicine and rehabilitation and may qualify for federal funding through Medicare since the hospital has not offered a program before.

The big concern moving forward is having more medical school graduates than training slots in the country, Postlewaite said.

“There are only two ways to change or improve that,” he said. “Hopefully, the United States government will allow increased funding to the institutions that already have graduate medical education, or going to hospitals that currently don’t have graduate medical education and starting new programs.”

In the written statement released by the AAMC, Kirch urged Congress to introduce legislation into the House and Senate to train an additional 4,000 physicians per year, as well as develop team-based practices and new health care delivery models.

“At some point it will be a breaking point and there will be just too few doctors,” said Gavan in reference to the residency issue.

“You don’t want a medical industry churning out medical students who can’t practice. At some point, we have to fix it, and Congress is the most likely starting point. Even if they are not going to fix it in totality, they at least have to be a little more flexible.”

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