New York has more medical residents than 31 other states combined and received almost 20% of all Medicare GME funding while 29 other states received less than 1%.
The uneven distribution of GME, researchers wrote, is important because it raises questions of fairness and because physicians tend to practice where they train.
“Unless the GME payment system is reformed, the skewed payments will continue to promote an imbalance in physician availability across the country,” Dr. Fitzhugh Mullan, the study's lead author and a professor of medicine and health policy at George Washington University, said in a news release.
According to Mullan's study, medical schools in New York, Massachusetts and Pennsylvania “took root in the first half of the 20th century” and were “well positioned to take full advantage” of a Medicare-funded medical education system.
Medicare spent $10.1 billion in 2010 to support the training of medical residents and fellows. But about 15,300 resident positions have been created since 1997 that don't rely on Medicare funding, authors noted. To boost their supply of physicians, some states have been contributing more to GME efforts, most notably New Jersey and Florida.
While Kenneth Raske, president of the Greater New York Hospital Association, didn't dispute Mullan's statistics, he disagreed with his conclusions.
“We produce the largest number of physicians in the United States by a long shot,” Raske said, explaining that “historical decisions” led to his state's dominance in GME, and he compared it to decisions that resulted in all the major automobile companies being headquartered in Detroit.
He also disagreed that concentrating GME in New York leads to physician shortages in other states. “We have shipped doctors all over the United States,” Raske said. “To believe they are landlocked in the place they trained is incorrect.”
Raske cited an October 2011 report by the State University of New York University at Albany's Center for Health Workforce Studies, which found that New York GME programs trained more than 17% of the nation's physicians—including 41.5% of doctors in New Jersey, 28.5% in Connecticut and 18.6% in Florida. While the Health Affairs report suggests that New York's GME funding may come at the expense of Mississippi, the 2011 CHWS report noted that 330 of Mississippi's 5,752 doctors (5.7%) were trained in New York.
Karen Heller, GNYHA executive vice president, said increasing funding for GME is what's needed and not redistribution of existing positions. “It doesn't make sense to redistribute because that's a zero-sum game,” Heller said. “Why do people come to New York to train? Because you get experiences that you can't find in other areas. They train here and then they go home.”
According to a study published in Health Affairs in January, a redistribution of some 3,000 GME slots mandated by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 failed to reduce primary-care and rural physician shortages as intended.
Follow Andis Robeznieks on Twitter: @MHARobeznieks
