The AMA GME committee gets it right

I recently met Paul Rockey. He is a gentleman who really understands the problems of graduate medical education. His commentary on Medscape is important.

The US faces a shortage of doctors. To address this need, we must expand graduate medical education. That’s because all licensed physicians in the US must pass through GME. In 2003, the Council on Graduate Medical Education predicted a shortage of physicians and recommended a 15% increase in output.[1] More recently, the president of the Association of American Medical Colleges called on US medical schools to increase production by 30%.[2,3] Both allopathic and osteopathic medical schools are increasing class size, and more than a dozen new schools are planned.

Currently, almost 19,000 MDs and DOs graduate each year. A 30% increase means 5700 more US graduates seeking residency training, but that equals the current number of international medical graduates entering GME each year. Unless we expand GME soon, the growing numbers of US MDs and DOs will only compete with IMGs for the same number of residency slots. The pool of applicants will be bigger, true, but the number coming through the GME pipeline and entering practice will be the same.

So what must change? Most of US GME is funded by Medicare and Medicaid. In 1997, caps were placed on the number of resident positions funded by Medicare. The American Medical Association believes these caps should be lifted and residency programs allowed to grow in those regions and specialties which need more doctors. We also believe that all payers (not just Medicare and Medicaid) should contribute to the costs of GME.

Both these issues — lifting caps and spreading costs of GME — require action. The AMA encourages physicians to take the lead in recognizing the impending doctor shortage, increasing the number of residents, and obtaining funding for GME from all payers.