“Well, if medicine doesn’t work out, you can always fall back on waiting tables,” I joked with my waiter, who, like me, happens to be a medical student. We were bonding over completing our first year of medical school — he, in Detroit, and myself, in the Bronx. He liked waiting tables and decided to work during his last summer of freedom before the slew of exams and clinical work that would follow. But as much as he enjoyed serving diners, his dream was to serve patients as a physician.
At the time, I thought that the prospect of medical students being unable to become practicing physicians was inconceivable, even absurd. But soon, despite the nation’s physician shortage of more than 16,000, it’s possible that MD students will be graduating with four years of intensive schooling, an average debt of $166,750 — and no job.
President Barack Obama’s proposed budget would cut $11 billion from Graduate Medical Education (GME) funding in the next ten years. While I am deeply concerned about the future of medical graduates, I am even more concerned about the future of our nation’s healthcare. These proposed cuts could force teaching hospitals to lay off as many as 73,000 staff, reduce clinical research support, shut down training programs for health professionals, and eliminate services that are unavailable elsewhere in the community. Although there is a pressing need to reduce the federal budget deficit, this short-sighted solution will hinder our healthcare system.
With the Patient Protection and Affordable Care Act that President Obama championed, the demand for physician services will increase significantly in 2014 as 30 million Americans are added to the healthcare system. The United States is projected to face a shortage of 62,900 physicians across all specialties in 2015. That number is expected to double to 130,600 by 2025. But health care coverage is useless if there are no physicians to treat patients, or if long waitlists leave patients unable to access care.
Even with new medical schools and increasing class sizes in existing schools, the number of practicing physicians is limited by funding for GME or residency programs. In fact, the number of residency slots funded by Medicare has been capped since the 1997 Balanced Budget Act. President Obama’s proposed cuts will only exacerbate the physician shortage, resulting in fewer doctors.
After medical school, MDs must complete an accredited core residency program to be certified by the American Board of Medical Specialties. Physicians must be certified to practice and to be included in insurance plans. Osteopathic and international medical graduates, many of whom become primary care practitioners, depend on residency funding as well.
Residents work under the supervision of fully licensed physicians for three to seven years depending on their specialty. During this time, residents provide care for one of every five hospitalized patients, including seniors, veterans, and the underserved.
Many residents train at teaching hospitals, which provide care for 28 percent of all Medicaid hospitalizations. While teaching hospitals make up 6 percent of hospitals in the nation, they provide 40 percent of all charity care at a cost of $8.4 billion annually.
Teaching hospitals rely on GME funding for clinical research and specialized services, including a large majority of Level-I trauma centers, pediatric ICUs, burn care units, surgical transplant services, Alzheimer centers, and ambulatory services for HIV/AIDS patients. President Obama’s proposed cuts could force hospitals to eliminate services that operate at a loss, affecting the most vulnerable patients.
GME benefits all of society by providing valuable services and producing physicians who provide a high standard of care. By urging your Congressional representative to protect federal GME funding, we can safeguard the health of our nation. Take action at www.SaveGME.org.
Although the $11 billion in cuts have not been made yet, we’re already seeing the effects of inadequate GME funding. This year, there were 1,958 more applicants competing for residency slots than in 2012. By 2015, there might not be enough residency slots for U.S. medical school graduates.
Even though 99.4 percent of available residency slots were filled — the highest fill rate ever — 528 U.S. medical graduates couldn’t enter a residency program this year. That’s more than double the number of graduates from last year.
Three percent of U.S. medical school seniors did not obtain a residency slot in 2013. If that rate holds up, six out of the 183 students in my class may not have residency positions despite being some of the most intelligent, compassionate, hardworking and well-qualified people I know. As for the medical student waiter? I wonder what will happen to him. I wonder what will happen to our patients, to my classmates, to myself. And I have to ask, “Would you like fries with that?”
Christy Duan is a medical student.
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