Proposed law would rework residency spending to increase primary care

Regarding "We have more students, now what?" (Article, Oct. 22/29): The article asks a very important question that should have been asked long ago. Projected physician manpower shortages of crisis levels are convenient rallying cries for the opening of more medical schools and the expansion of medical school classes. This is particularly true in osteopathic medicine, which has experienced a massive proportional expansion of students through the opening of new medical schools and expansion of class sizes. This will intensify now that the Commission on Osteopathic College Accreditation has allowed the opening of the first for-profit American medical school since 1930.

The Resident Physician Shortage Reduction Act of 2007 is one small step in answering the question.

This bill, in Congress, not only increases the total number of residency slots since the cap of 1997, but it specifically directs that the increase be in states with a shortage of resident physicians and directs the Secretary of the Dept. of Health and Human Services to consider whether the slots are in primary care, geriatric or preventive medicine.

Medicare, which funds the majority of graduate medical education in the U.S., has traditionally been reluctant to leverage its funding to address work force manpower goals. That is, all residencies are funded equally, without regard for geographic distribution or specialty area. This has resulted in today's situation of oversupply of plastic surgeons in desirable locations and undersupply of family physicians nearly everywhere. As resources dwindle, the Centers for Medicare & Medicaid Services will have to make difficult decisions about which residencies should be funded, if it chooses to fund GME at all.

Although the paradigm of American health care may change to include a greater role of nonphysician practitioners, this will not happen overnight. A rational use of Medicare's limited resources in funding GME to areas of specific need is essential if we are to meet the challenges posed by the retiring baby boomers. As you quite correctly state, "Doing nothing is the worst option of all."

George Mychaskiw II, DO, Jackson, Miss.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2007/12/03/edlt1203.htm.