The number of residents at teaching hospitals rose slightly in 2013, the last full year before the fiscal 2015 federal budget cut $960 million from graduate medical education support, according to data compiled by Modern Healthcare.
The GME budget cuts, which could total $14.6 billion through 2024, have made the prospect of growth in the number of physician trainees murky, medical education experts said.
Teaching hospitals need to find creative ways to fund residency programs, noted Dr. Mitchell Morris, the U.S./Global Health Care Providers sector leader at Deloitte Consulting. “The current formula doesn't work,” Mitchell said. “We must invest in young physicians.”
The total number of residents at the nation's teaching hospitals rose 3.4% in 2013 compared with 2012, according to data supplied by the American Hospital Directory for Modern Healthcare. The numbers will continue to increase slowly. Some teaching hospitals are adding trainees even if it impacts their bottom lines.
At UAB Hospital, the University of Alabama at Birmingham School of Medicine's teaching hospital, for example, the number of residents rose to 850 in 2014, 1.6% more than the 837 residents in 2013, when Modern Healthcare ranked it sixth.
The program is growing even though hospital money has to be spent to fund that growth, said Dr. Gustavo Heudebert, associate dean for graduate medical education at UAB. “We've added positions knowing it'll cost us,” he said.
Staff needs also have forced the school to hire in other areas. The hospital has continued to bring on more nurse practitioners to compensate for flat residency growth, Heudebert said. Over the past decade, there have been consistently 250 more NPs than residents each year at the facility.
However, simply adding NPs to the staff isn't a cure-all. In the more conservative South, the duties of an NP can be more restricted than in the Midwest or West regions, Heudebert said. “It's amazing how different solutions are in different parts of the country,” he said.
In addition to staffing issues, the possibility that the number of medical school graduates will eventually outpace residency slots concerns experts.
Dr. Atul Grover, chief public policy officer at the Association of American Medical Colleges, said about 27,000 first year residency positions exist right now, a number which has risen less than 1% a year on average. But, M.D. and D.O. enrollment has grown faster, Grover said, and growth in medical school enrollment may continue to outpace the small growth—or, if there are cuts in GME funding—decline, in first year GME positions.
It's unlikely the country will see more graduates than first year residency spots in the next two to three years, Grover said, but he does worry that congressional inaction could negatively affect the balance between U.S. graduates and first-year training positions.
“We need to be training a couple more thousand doctors per year, but the money isn't there,” he said.
Follow Michael Sandler on Twitter: @MHmsandler