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Expanding the Pipeline: Congress Considers Residency Legislation

June 28, 2023

It is a fundamental of physics: a narrow funnel can inhibit the rate of flow. Consider, if you will, the hourglass. You can have a pound of sand at the top that would quickly fall and fill the cavernous section at the bottom if it weren’t for that narrow passageway connecting the upper and lower chambers of the glass. Similarly, it is clear that the wider your waterline or expanded your gas line, the quicker you can count on larger quantities getting to their designated destinations. Unlike our waistlines—in this context—wider is better.

Pinpointing the Problem

We have a pipeline problem when it comes to a specific segment of the medical provider community. We have addressed on more than one occasion in recent months the nursing shortage crisis, especially as it affects hospitals. Those with a pedantic penchant might more precisely point out that there is not a shortage of RNs in the country; rather they just aren’t showing up in our hospitals in sufficient numbers. They’re either in other clinical capacities or working in different careers or not working at all. We would be remiss, however, if we did not point out at this juncture that there is a physician shortage in this country, as well.

Long before the ravages of COVID, many labeled the dwindling numbers of doctors to patients as a crisis. Indeed, according to a recent study from the Association of American Medical Colleges (AAMC), the United States is facing a shortage of up to 124,000 physicians. With the continuing aging of the U.S. population, this troublesome trend is threatening to only get more acute.

One reason consistently given over the last few years for the doctor shortage crisis is the lack of residency programs and positions available for prospective physicians. Remember our opening discussion of the hourglass with its narrow funnel? This is analogous to what’s happening with the current distribution of doctors across the United States. Regardless of how many individuals are seeking to go into the medical profession, if there is a bottleneck in the availability of residency positions, this limits the number of current and future physicians available to staff our nation’s hospitals.

Working toward a Solution

In an effort to address this component of the crisis, a bill was introduced in the U.S. Senate this spring that seeks to widen the pipeline for new doctors. The Resident Physician Shortage Reduction Act of 2023 contains provisions that will greatly expand residency positions. Specifically, the legislation would combat the nation’s current and projected shortage of physicians, as well as improve access to healthcare, by expanding the number of Medicare-supported medical residency positions by 14,000 over seven years. To put it another way, the bill provides for an additional increase of 2,000 positions per fiscal year, from FY2023-FY2029. During this period, each hospital may receive up to 75 additional positions in total under the bill in combination with current law.

The bill’s introduction met with widespread approval from several quarters, including the American Hospital Association (AHA). A letter written to the bill’s sponsors was effusive in its praise of the pending legislation. The following is an excerpt from the AHA letter:

Thanks to your leadership, Congress provided 1,000 new Medicare-supported GME positions at the end of 2020 and 200 additional positions in 2022 – the first increases of their kind in more than 25 years. Your legislation would build on Congress’ historic investment by increasing the number of Medicare-supported residency positions by 2,000 each year for seven years, for a total of 14,000 new slots. A portion of these positions would be targeted for hospitals already training over their caps, hospitals in rural areas, hospitals in states with new medical schools or branch campuses, and hospitals serving areas designated as health professional shortage areas.

So, it looks as if the spigot is being turned on and the pipeline will be widened to allow for a greater influx of physicians heading to our nation’s hospitals. While this may not be the silver bullet that provides a comprehensive solution to the long-term doctor shortage crisis, it is at least a good start. It remains to be seen, however, if increasing the number of residency slots, alone, will be enough to keep up with the surging Medicare population, as well as the yearly growth in the general population. The sands of time will tell.

With best wishes,

Chris Martin
Senior Vice President—BPO

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