Bills aiming to alleviate physician shortages

Washington -- The federal government would spend millions enticing newly minted doctors to practice in underserved areas or specialties, under legislation recently introduced by Rep. Michael Burgess, MD (R, Texas), one of a handful of physicians in Congress.

Factors such as low pay, long training and high medical liability costs drive many new doctors from underserved areas or specialties, Dr. Burgess warned in a June 12 congressional speech. "Young people ... who want to consider a career in health care are looking at the crisis we face in medical liability in this country, and it's keeping them out of the game," he said. Rural and inner-city hospitals cannot afford the $100,000 cost to train a resident, he added.

So Dr. Burgess, who practiced obstetrics-gynecology, introduced the Physician Workforce and Graduate Medical Education Enhancement Act of 2007. The bill would set aside $25 million to make interest-free loans to rural or urban hospitals for starting a residency program. The program would have to be in family, internal or emergency medicine; pediatrics; obstetrics-gynecology; or general surgery.

Dr. Burgess also introduced the High Need Physician Specialty Workforce Incentive Act of 2007. The bill would establish scholarships, loan forgiveness plans and tax incentives for doctors entering the same targeted specialties. Scholarships could be up to $30,000 and would be exempt from taxes. The federal government would forgive up to $35,000 in debt for each year of service.

The bill also would create grants to physicians who provided care in "qualified medical homes." The grants also could be used for geriatric fellowship programs to train doctors practicing in the five targeted specialties. The total cost of the measure is $21 million from 2008 to 2012.

The bipartisan Burgess bills are "right on track," said American College of Physicians President David C. Dale, MD.

"The crisis in primary care is a huge problem for our country," he explained. Physicians often take early retirement from primary care practices, while increased regulation and decreased funding are discouraging doctors who remain. At the same time, the interest among students and residents to enter primary care is tailing off, he added.

"Those three elements to the collapse of primary care are a national health issue," Dr. Dale emphasized.

The American Medical Association is reviewing both bills. The AMA supports making Medicare direct medical education costs per resident more equal across teaching hospitals. It also supports stabilizing funding for pediatric residency training in children's hospitals and increasing the number of graduate medical education positions in underserved areas and specialties.

The Association, which recognizes there are physician shortages in many regions and specialties, also encourages Congress to consider incentives, such as tax credits and loan forgiveness, for physicians working in underserved areas.

Trouble ahead

National surveys confirm that a physician shortage looms. A study by the Council on Graduate Medical Education projects an overall shortfall of 85,000 doctors by 2020. A report by Richard Cooper, MD, director of the Medical College of Wisconsin's Health Policy Institute, predicts a shortage of 200,000 by 2020.

The American Academy of Family Physicians in September 2006 reported that 41.6 primary care doctors per 100,000 residents would be needed in 2020 to meet the nation's needs. But there were only 31.2 primary care doctors per 100,000 residents in 2004.

The Assn. of American Medical Colleges' Center for Workforce Studies found that the physician shortage results from population growth, aging baby boomers, physician retirements and younger doctors limiting their hours of practice.

Also playing a role is medical school enrollment, which held steady at approximately 16,000 per year between 1980 and 2002, according to the AAMC center. During that period, the U.S. population grew by 71 million. Medical school enrollees per 100,000 population dropped from 7.3 in 1980 to 5.6 in 2005, the center discovered. The ratio will drop to 5 per 100,000 by 2020 if current trends continue.

In June 2006, the AAMC called for the nation's allopathic medical schools to boost enrollment during the next decade by 30%.