Several lawmakers on Thursday expressed support for expanding the number of Medicare-funded graduate medical education slots, but provider groups want them to go a step further in diversity efforts.
Sens. Chuck Schumer (D-N.Y.) and Bob Menendez (D-N.J.) have proposed adding 14,000 GME slots over a seven-year period to help address the looming physician shortage. The Association of American Medical Colleges predicts the U.S. will need 139,00 more physicians, including 55,000 primary care physicians, by 2033. Those estimates don't factor in clinicians who left the profession or died during the COVID-19 pandemic.
But simply adding more slots is not enough, according to experts before the Senate Health, Education, Labor and Pensions Committee during Thursday's hearing. The witnesses called for more work on improving diversity in physician ranks, which could improve care for rural and underserved communities.
"We know primary care access results in cost saving, improved health disparities and outcomes," said Dr. Leon McDougle, president of the National Medical Association. In one study an additonal 10 primary care physicians per 100,000 population extended life expectancy by 51.5 days.
Sen. Bernie Sanders (I-Vt.) recommended incentives to expand the primary care and rural healthcare workforce through loan repayment programs. He said these incentives would encourage more in residency to pursue primary care training programs, which pay less on average than other residencies. He also expressed support for adding criteria to GME slots, such as allotting 50% to primary care physicians or rural facilities.
Urban areas account for 99% of GME spending under Medicare and while the Government Accountability Office says there is likely more than 1% spent on rural training, a lack of available data makes this uncertain, according to a 2018 report.
Training more healthcare professionals in rural areas is a crucial step toward improving health equity, according to Sen. Susan Collins (R-Maine) and David Skorton, President of the Association of American Medical Colleges (AAMC). They agreed incentive programs and doubling last year's Title 7 funding, which provisioned training for healthcare professionals within the CARES Act, is a good place to start.
But efforts to diversify the healthcare workforce will require new residency programs and more GME slots going toward underrepresented groups, they said. Collins requested 1,000 new residency positions focused on addiction, citing Maine's rise in opioid-related deaths during the past year.
An AAMC study found the number of Black men enrolled in medical school comprised 2.4% in 2014 and grew to just 2.9% in 2020. Experts reason this could result from the high costs of training, which can take a physician up to a decade with residency and graduate programs. However, investing in increasing black men and women in the workforce has proven to improve health equity among underserved communities. McDougle says the medical schools awarded for having the highest social mission scores, which in part are determined by the number of primary care physicians and where they practice, were historically black colleges and universities such as Morehouse and Howard University.
An additional 1,000 GME slots were added in last December's year-end spending and COVID relief bill, the program's first increase since 1996. A cap was placed on these slots by lawmakers who feared a surplus of residents would be too much of a burden on Medicare funds. Some say more slots could be added to the upcoming infrastructure packages, which allocate $400 billion toward expanding access to home and community based care. Provisions on Medicare spending would need to move through the House Ways & Means Committee, where Chairman Richard Neal (D-Mass.) and Senator Chuck Schumer (D-N.Y.) have expressed support for the issue.