A call for expanding residency slots: Medical school graduates may face a bleak future

The United States is facing physician shortage in the not-so-distant-future. The Association of American Medical College found physician demand will surpass supply by approximately 46,000 to 90,000 physicians due to an aging population and increasing number of insured individuals.

Despite this deficiency, medical students are fighting for a limited number of residency slots. Currently, there are 175 medical schools across the United States, and the number is growing to combat the looming physician shortage. However, medical school enrollment has increased 25 percent since 2002 with an all time-high of 20,630 enrollees in 2015, according to AAMC.  

In 2007, The Association of American Medical Colleges implored states to increase the number of medical graduates by 30 percent by 2015, according to PEW Charitable Trusts.

Residency slots have not increased at nearly the same rates, leaving medical students without a residency position stuck in limbo. In March 2015, The National Resident Matching Program had a rather successful year matching graduates with residency slots. NRMP measures a successful match based on two criterion — volume and how well it matches the applicants and program directors' preferences. NRMP found an overall position fill rate of 95.7 percent. While 2015 marked the most successful match on record, it begs the question — what about the remaining 4.3 percent?

Increasing the number of residency slots is not a simple feat. The Balanced Budget Act of 1997 limits the number of residencies Medicare is able to fund.  Medicare helps cover the financial costs associated with training each resident, which the AAMC estimates is approximately $150,000 each year. 

Therefore, states and healthcare facilities have to pay for residency slot creation, and a large portion of hospitals do not have residency programs or necessary Medicare funding. Many states are implementing measures to encourage hospitals to create residency programs. For example, Texas offered hospitals $150,000 planning grants and an additional $250,000 to develop the programs. Those hospitals already equipped with residency programs could apply for $65,000 to add slots. Additionally, Texas designated $56 million to help expand residency programs through 2018.

Some members of the medical community claim the United States is granting too many residency slots to non-U.S. citizens. According to the Educational Commission for Foreign Medical Graduate, of the 12,482 students who participated in the 2014 Match, 7,334 IMG participants were not U.S. citizens. Of this cohort, 49.5 percent of 3,633 participants received first-year residency positions. 

In July 2014, the American Osteopathic Association passed a resolution imploring the medial profession to push forth federal legislation granting U.S. medical school graduates priority of U.S. residency positions. Robert Goldberg, DO, dean of the Touro College of Osteopathic Medicine in New York, said, "There’s a collision between the numbers of graduates of U.S. medical schools and the limited number of residency positions currently in the United States."

In 2015, Rep. Joseph Crowley (D-NY) and Charles Boustany Jr. (R-La.) proposed The Residency Physician Shortage Reduction Act of 2015. The legislation would increase the number of Medicare direct medical education and indirect medical education slots. The bill mandates National Health Care Workforce Commission to submit a report to Congress by Jan. 1, 2018, listing physician shortage specialties. The bill also increases by the number of residency slots nationally by 3,000 each year between 2017 through 2021 for a total of 15,000 slots.  Under the legislation, one-third of the new residency slots are allotted to teaching hospitals training over their cap, and at least 50 percent of the remaining available slots each year must be allocated for shortage specialty residency slots the National Health Care Workforce Commission identified in their report.

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