WE CAN’T AFFORD TO TRAIN FEWER DOCTORS

Seeking to reduce the federal budget, Democratic and Republican lawmakers are looking at cutting funds for graduate medical education. Specifically, they’re considering reducing the Medicare reimbursement for doctor training, possibly in half, to cut about $4 billion from the federal budget. This could dramatically limit the ability of patients to see physicians, even for critical illnesses.

Academic medical centers and teaching hospitals are where young doctors obtain the crucial skills they need to care for us all. As a part of Medicare, graduate medical education reimburses academic medical centers and teaching hospitals for about a third of the direct costs associated with training the next generation of doctors, including salaries, malpractice insurance, equipment, and the extra time necessary for senior doctors to teach procedures to new doctors. Some of the indirect costs of training are also reimbursed, including specialized standby capacity like burn treatment and intensive care.

Even now, not enough doctors are being trained. And population trends, coupled with the expansion of health insurance, indicate that funding for graduate medical education should be increased. If funding is cut, it will reduce the number of well-trained doctors at the very time demand for more doctors is growing.

The result for patients? Longer waits, from the parent seeking a “well baby” visit to the recipient of a new pacemaker needing follow-up care.

Patients already have a taste of the future, even without the proposed cuts to graduate medical education. Statistics from the Department of Health and Human Services show that 10% of the population today may wait months to see a doctor.

Just five years ago, 70% of doctors’ offices were independent physician practices. Now, less than half of doctors own their own practice. Instead, they work in offices owned and operated by hospitals. If this trend continues—and we have no reason to expect it won’t—in a few short years private practices will be rare.

The result is that hospitals, through their doctor practices, now provide most of the primary care in this country, most of the outpatient care, and most care for the indigent. However, this means that if one area of a hospital receives a cut in reimbursement, such as a cut in graduate medical education, it will impact all services that hospital provides to the community.

The implications of fewer doctors will be profound as the population ages and requires more medical care. By 2020, census data estimate 72 million Americans will be seniors, nearly double today’s number.

Doctors are aging, too. Almost a third of them are over 55, about 250,000. So just as the number of patients increases, more doctors will retire and be unable to care for them.

According to the Association of American Medical Colleges, we will need at least 90,000 additional doctors by 2020 to meet this increased demand, almost equally divided between general practice physicians and specialists. Five years later, the need for doctors is expected to grow to 130,000.

To keep pace, this nation will need to train an additional 6,000 to 8,000 new doctors each year for the next 20 years, an enormous increase over the roughly 16,000 a year we now train under limits set by Congress. (In 1997, Congress incorrectly believed that the country would face a surplus of doctors so it set this limit by capping how many resident positions Medicare would pay for.)

To meet the demand, Congress must increase the number of doctors hospitals can train and not reduce the funding available for training. The short-term budgetary savings of graduate medical education cuts are not worth the long-term negative impact on patients.

Dr. Pardes is president and CEO of New York-Presbyterian Hospital. Dr. Miller is dean and CEO of Johns Hopkins Medicine