On July 1, as hundreds of medical school graduates start their three- to seven-year hospital and clinic residency programs at Michigan's 88 teaching hospitals and other program sites, almost simultaneously hundreds of other residents in Michigan have completed their training.
There also appears to be a slight uptick in residents staying in the state after their training ends, several experts told Crain's, although no hard survey data exists.
Many residents like Khogali-Jakary and Abood who completed their training are off to join the full-time physician workforce in Michigan. Others will continue their training in a subspecialty fellowship or second specialty residency program either in Michigan or another state, Sealey said.
But most of the young physicians going into practice in Michigan are expected to help replace some older doctors who are nearing or at retirement age. They will help ease the predicted coming shortage of physicians, especially in primary care.
On the 11 other residents at Authority Health who decided to leave Michigan or continue their training elsewhere, Khogali-Jakary said she believes some of her friends will return to Michigan. "The majority are interested in serving the communities they trained in," she said. "Some are going for more training and hoping to come back."
Sealey said the goal of Authority Health's teaching health center residency program was twofold. First, to contribute to the effort to reduce the estimated 2,000 shortage of primary care physicians in Michigan. Second, to provide skilled medical practitioners to care for an expanded Medicaid population under Obamacare and alleviate access problems through community health clinics.
Because of an aging population, retiring physicians and Medicaid and private insurance expansion, Michigan may need 12 percent more primary care physicians by 2030 than the 16,200 it currently has, according to a 2015 report by the Citizen Research Council of Michigan.
Atul Grover, M.D., executive vice president with the Association of American Medical Colleges, said data show the primary care shortage does appear to be easing — especially in states like Michigan that have expanded medical school enrollment and have large residency programs — but worsening for some specialty services like surgery, dermatology and oncology.
"There has been an increase in the proportion of primary care physicians. We still have shortages, but smaller than in the specialties," Grover said.
By 2030, however, the U.S. is projecting a shortage of 60,000 to 100,000 physicians, with primary care shortfalls pegged at 35,000, the AAMC said in a recent workforce report.
But in 1997, Congress capped federal funding of residency positions to slow the federal deficit. Hospitals such as the University of Michigan, Henry Ford and Beaumont self-fund residency positions when they exceed their cap, which differs from hospital to hospital. Currently, the nation's teaching hospitals are 13,000 residents over the federal funding cap. UM currently is about 240 residents over its cap, Kolars said.
Current bills in the U.S. House and Senate call for expanding graduate medical education funding through Medicare by 3,000 additional residents annually for the next five years. Most experts are pessimistic about the chances for Congress this year to spend $1 billion on 15,000 resident doctors, regardless of the need.
But because teaching hospitals hire only about 27,000 first-year positions, about 9,000 medical school graduates each year fail to match in a residency program. Many try the next year, but a large number go into other fields with six-figure medical student loans to pay off.
"If we don't get the cap raised," Grover said teaching hospitals will continue to match only about half of the U.S. IMGs, or about 2,500. "We need more doctors and adding 3,000 per year will help make a dent" in the projected shortages, he said.
In Michigan, a 2015 federal report concluded that there are 299 physician shortage areas in the state and that Wayne, Chippewa, and Montcalm counties have the highest number of shortage areas in the state, according to the U.S. Health Resources and Services Administration.
Creating greater access to care for patients and addressing the shortage of primary care physicians are the two main problems the Authority Health teaching health center program seeks to address, Sealey said. Primary care specialties include pediatrics, family medicine, obstetrics and gynecology, internal medicine and psychiatry.
While most residency programs are incorporating more community medicine into their curricula, Sealey said Authority Health does more because it is designed as a teaching health center program.
"When I was in training I would come in the back door of the hospital, stay on duty for two days and when I was done go back out the door and go home. I wouldn't stay in the community," Sealey said. "Our program really is a reversal of that."
Authority Health residents train at DMC Sinai Grace Hospital, DMC Children's Hospital, the Detroit VA and Providence Hospital in Southfield for psychiatry. They also rotate through several private physician offices and two federally qualified health centers in Southeast Michigan — including Detroit Health Connection and Western Wayne Family Health Centers.
Sealey said as good as Authority Health's teaching health center program is — one of 59 other programs with 550 residents funded through Obamacare and HRSA — there is a chance funding will run out Sept. 30.
After the $230 million Obamacare grant ended in 2014, Authority Health received a two-year, $16.5 million grant extension through HRSA in 2015.
Grover said it is likely that funding for the teaching health center program will be approved this summer because it is part of a larger $3.6 billion community health center fund reauthorization.
"We are hoping to craft a bill with Republican and Democratic support to reallocate those funds for three to 10 years," Sealey said. "We don't know yet. We hope the program will be reallocated. ... If it isn't, Michigan State will do what it can to keep the program going or find positions for the residents."
"Addressing the doctor shortage: More than 1,500 medical residents complete training in Michigan" originally appeared in Crain's Detroit Business.
