Outdated federal laws have created an impending shortage of trained doctors, but several graduate medical education provisions in the COVID-19 relief bill signed into law late last year are a significant step toward tackling the nation's inadequate pipeline of future physicians.
Among other GME provisions, the bipartisan Consolidated Appropriations Act of 2021 gives America's teaching hospitals new Medicare-supported residency slots for the first time in two decades.
Long before COVID-19, the Association of American Medical Colleges warned of an impending physician shortage that could reach 139,000 by 2033. The pandemic has since magnified shortfalls in the primary- and specialty-care physician workforce. Coupled with the significant healthcare needs of the nation's aging population, expanding the physician workforce pipeline has become a necessity.
For most teaching hospitals, support for residency positions has been capped under a 1997 law intended to curtail Medicare spending. Over the years, the law has stifled the growth of the national physician workforce and threatened to narrow access to care.
The GME provisions in the COVID-19 relief bill finally reverse this stagnation.
Most important, the bill allows hospitals to take on new doctors-in-training by authorizing Medicare to support 1,000 new residency slots. Teaching hospitals must apply for the slots through an application process, and Medicare will prioritize hospitals in rural areas, hospitals that are training some residents without Medicare support, hospitals in states with new medical schools, and hospitals that provide care for underserved communities. The Resident Physician Shortage Reduction Act of 2019—a bill long supported by the hospital and physician communities that would create more new residency slots and enjoys strong support in Congress—provided the legislative framework for this provision.
The COVID-19 relief bill also removes long-standing barriers that have prevented urban teaching hospitals from partnering with rural-area hospitals to cross-train medical residents, and allocates Medicare funding that will allow some hospitals to start new residency programs.
The ongoing pandemic has reminded us that an adequate supply of doctors and other healthcare workers is essential. Increasing residency slots in teaching hospitals will get us closer to solving the looming physician shortage and ensure that hospitals and other healthcare providers are better prepared for future health crises.
The violence at the U.S. Capitol on Jan. 6 and developments since are a stark reminder that our country and Congress are deeply divided. But with this bill, new Senate Majority Leader Chuck Schumer (D-N.Y.) and the committees of jurisdiction reminded us that it doesn't have to be this way. They took bipartisan action to improve our healthcare delivery system. Democrats and Republicans managed to find common ground with this much-needed expansion of the physician workforce. Working with the Biden administration, the new Congress should further expand GME training and create an even greater supply of future physicians.
Let's keep the spirit going. We have much more to do as a country. For example, Congress should act swiftly on President Biden's COVID-19 relief proposal and the need to provide additional financial relief to hospitals, perhaps by considering loan forgiveness of the Medicare Advance Payments they received to help them deliver care during the pandemic.
In addition, the COVID-19 crisis has worsened the nation's deteriorating healthcare infrastructure. The White House and Congress should work together to ensure that any proposed infrastructure legislation addresses inner-city and rural hospitals' access to capital financing, access to health information technology (including telehealth programs), and healthcare workforce development.
The hospital community stands ready to work with Democrats and Republicans to further improve the nation's healthcare delivery system.