Any Future COVID-19 Response Needs to Address Physician Workforce Shortages
Kristen Conrad-Schnetz, DO, FACOS, FACS
It is no secret that physician shortages will be part of our not-so-distant future. Even before the full effects of the COVID-19 pandemic become apparent, the American Association of Medical Colleges (AAMC) predicted in its annual study of the physician workforce that by the year 2032 there will be a total physician shortfall of between 46,900 and 121,200 physicians, with 24,800 to 65,800 of those being specialty physicians. This shortage is multi-factorial and is primarily due to the growth of our population, the growth of those over the age of 65, and the lack of residency training positions.
Training residents is a shared expenditure between the hospital and Medicare, with Medicare supporting a large portion of the cost. In 2012 (the last year where data for ALL federal sources of graduate medical education payments were available), the federal government contributed nearly $15 billion for graduate medical expenses. However, given the clear limit on the number of residents Medicare supports, if additional spots are added to a GME program, funding for those additional spots is largely the responsibility of the hospital system.
As the Program Director for General Surgery Residency at a small community hospital outside of Cleveland, Ohio, I recently completed a step that will allow us to continue to produce highly qualified, well-trained, competent general surgeons — by transitioning from an American Osteopathic Association accredited program to one accredited by the Accreditation Council of Graduate Medical Education (ACGME). When I interview osteopathic medical students applying to our program for potential residency slots, I speak to my future plans for shaping the program and improving on our already strong foundation of surgical education. This includes applying for an expansion from two categorical residents per year to three once we achieve continuing accreditation from ACGME. Our institution, like many others, however, will have to shoulder the cost to train any approved additional resident positions above our federally imposed cap.
Yet, with early indicators showing the financial turmoil hospitals are experiencing due to the COVID-19 pandemic, it may not be wise to count on them to fund additional residency slots in the future. This risk comes at a time when over the next 10 to 15 years, the AAMC predicts the supply of surgeons is not expected to change significantly. For surgeons alone, the projected deficit is 14,300 to 23,400 full-time employees by the year 2032 despite filling nearly 100% of available residency spots in the National Residency Match Program match over the last five years. In my areas of specialty, both allopathic and osteopathic medical schools have responded to the call by the AAMC to increase the supply of student physicians, increasing first-year enrollment by over 30% between the years 2006 to 2018. Many of those graduates will face difficulties finding a home to train, as the corresponding number of residency slots has only risen marginally.
The still greater unknown is just how many doctors our country will actually need given the continued strain on our healthcare infrastructure and how many doctors we may lose due to contraction of the coronavirus, burnout, or early retirement especially in cases of those who have served at the epicenter of such a dire public health emergency.
While Congress has been extremely generous in approving nearly $3 trillion in COVID relief packages, any future federal response needs to address the long-term needs of the physician workforce in both primary care and in specialties like mine. That is why the Alliance of Specialty Medicine is asking Congress to address the physician workforce shortages in many specialties that will jeopardize access to care by passing the bipartisan Resident Physician Shortage Reduction Act (H.R. 1763/S. 348). Introduced in the House by Representatives Terri Sewell (D-AL) and John Katko (R-NY), and in the Senate by Senators Bob Menendez (D-NJ), John Boozman (R-AR), and Charles Schumer (D-NY), this legislation will increase the residency positions eligible for GME payments under Medicare by 3,000 positions per year for five years.
It can take anywhere from seven to ten years to produce a doctor, depending on their specialty. We’ve had four major public health emergencies in the past twenty years (SARS, H1N1, Ebola, and COVID-19). Not all hospital systems have the financial support to appropriately grow their programs to address increasing patient numbers or the framework to teach physician trainees, and even fewer may be able to do so coming out of the COVID-19 crisis. Our country needs a long-term solution to the specialty physician shortage. An important first step will be increasing the cap for federally funded residency positions in order to provide the access to quality healthcare our communities deserve.
Kristen Conrad-Schnetz, D.O., FACOS, FACS is a General Surgeon at Cleveland Clinic South Pointe Hospital, where she serves as the Program Director for the General Surgery Residency and as the Director for the Department of Surgery. She also serves on the Board of Governors of the American College of Osteopathic Surgeons, which is a member of the Alliance of Specialty Medicine.