Preparing for an uncertain future is never easy, but it's always better than the alternative of simply standing pat.
Today, the primary-care field is faced with precisely that challenge—as projections that an aging, growing population will drive up demand are arriving at the same time major shortages of primary-care practitioners are already affecting many communities.
According to research published in the Annals of Family Medicine, an estimated 44,000 additional primary-care physicians will be needed by 2035. If current trends continue, analysts expect a shortage of nearly 33,000 physicians in the field—or 75% of the total needed.
Graduate medical education—the system by which the CMS pays to train America's physicians in residency and fellowship programs—is key to addressing those shortages. And although the current GME system does a sound job training and preparing subspecialist physicians, it is falling short in terms of producing the number of physicians who will be needed to adequately serve patients.
A recent report from the Government Accountability Office finds that, while the total number of residents increased by 13.6% from 2001 to 2010, the number expected to enter primary care decreased by 6.3%. In addition, only 5% of family medicine residents go into subspecialty practice, compared with 55% of internal medicine residents and 39% of pediatric residents who enter subspecialty practice.
In part, that's because we're using an outdated education and financing model that isn't aligned with the practice of medicine in the 21st century. The legacy formulas that determine how our nation pays for GME were created nearly 50 years ago, with only minor changes in the interim.
Much of the current situation reflects the flow of GME funding through academic medical centers in urban areas. Most of that money goes to train subspecialties that practice in hospitals, rather than community-based primary-care specialties—which reflects a serious disconnect between how taxpayer dollars are used and our national healthcare needs.
There are, however, simple steps the federal government can take to address the shortage. For starters, Medicare could limit payments for direct GME and indirect medical education to training of residents in primary programs: family medicine, general internal medicine, obstetrics and gynecology, and general psychiatry. Additionally, funding the National Health Care Workforce Commission could also improve these efforts. Unfortunately, the commission was established in 2010 but has since been dormant; there has been no funding provided.
To be sure, federal efforts including the Teaching Health Center Program, the Primary Care Residency Expansion program, the Veterans Affairs GME expansion and the Medicare GME redistribution program have had some effect in increasing the number of residents entering primary care and practicing in rural areas. These efforts, however, still represent a relatively small investment. In fact, the average annual funding for these programs accounted for less than 1% of the more than $15 billion in estimated annual federal spending on GME.
What's more, some of the new primary-care GME training added through the federal efforts may not continue, in part because the Primary Care Residency Expansion program and the Medicare GME redistribution were one-time efforts that have ended. Funding for the Primary Care Residency Expansion ended in 2015; the Teaching Health Center GME program must be reauthorized and funded before Oct. 1.
The GAO rightfully reiterated its call for a comprehensive and coordinated approach to guide healthcare workforce development. And HHS can get the ball rolling by assessing current workforce gaps and exploring ways to modify residency training to reduce the shortages.
Ultimately, Washington needs to focus on permanently funding programs and initiatives that can help ensure a steady flow of residents entering primary care in rural areas as well as other regions nationwide. By planning ahead now, our political leaders can avoid potentially devastating shortages. We need to ensure all of our communities will continue to have access to primary care in the decades to come.
