A quarter of a million dollars — that’s the amount of debt the average medical student in the United States owes after completing medical school. After all the late nights studying, the endless exams and selfless sacrifice, it’s human nature to expect a historically stable career as the reward — right? I mean, weren’t we all told that “hard work pays off” at some point in our lives? For budding physicians, not quite.
Every year, the medical community reveres the third Friday of March, also known as Match Day. This quasi-Holy Day of Obligation is when approximately 34,075 applicants find out which specialty of medicine they will pursue, or “match into,” in residency. That is an impressive number. However, if we take a closer look, the number of those who successfully matched represents approximately 80 percent of those who applied. This means that about 8,000 students, who spent the same amount of money to buy a five-bedroom house in Houston, were evicted from their dreams. So, what happened?
Historically, the number of residency positions has remained stagnant at around 34,000. This has mainly been due to the graduate medical education (GME) financing structure created by Medicare and (partially) Medicaid in the 1980s. During that time, most medical teaching, as well as most Medicare patient volume, flowed directly through hospitals. Despite the increasing shift towards outpatient modes of care, the ancient payment formulary that is still in place effectively traps the system. As Huey Lewis puts it, “Back in Time.”
This severe bottleneck created by the United States health care system leads to a glaring problem that we will inevitably see within the next decade: a physician shortage. The Association of American Medical Colleges (AAMC) predicts that by 2034, with an aging physician population in parallel to the overall U.S. population trend, the country alone would see a shortage of 37,800 to 124,000 physicians in the workforce. Exacerbated by the pandemic and the subsequent Great Resignation, nearly 20 percent of physicians and medical professionals cite increased workload and burnout as primary reasons of leaving the profession altogether within the next two years. Worse yet, these shortages will be disproportionately seen in rural areas and primary care specialties.
What is surprising is that despite the increased competition and uncertainty post-graduation, more people than ever are applying to medical school. For instance, during the 2021-2022 application cycle, over 62,000 applied — an increase of 13 percent from the record set just two years prior. As more medical schools open around the country, albeit not at the rate of applications, the momentum stops short at the root of the problem – the number of residency slots.
Of note, there has been one silver lining. In December of 2020, Congress passed a bill that provides over 1,000 new Medicare-funded residency positions over the next five years. Given this expansion was the first of its kind in nearly three decades, what is worrying is the possibility of another similar plan not happening for another 30 years.
At that point in time, we would already be at the height of a physician shortage and our health care system on the brink of collapse.
That is why, for more robust change to occur, the health care system would have to wean off its reliance on a Medicare stimulus as a means of expanding residency slots. Instead, more emphasis should be placed on direct Congressional action such as the Resident Physician Shortage Reduction Act of 2021 — a bipartisan bill that would introduce 2,000 new residency slots for seven years — that is currently in development hell in the halls of Congress. Additionally, these new positions should be prioritized in underserved rural and urban markets where there is an increasing need in training competent medical professionals for future care.
In basic economic terms, there is high demand and a seemingly high supply. However, there is a problem when the supply cannot meet the demand due to obsolete systemic origins. Hard work pays off in most industries. With the emotional, financial, and time investment that medical students and their families make, it should also hold true for us.
Advait Suvarnakar and Aashka Suvarnakar are medical students.
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