Bill would raise cap on Medicare-funded residency slots

Legislation would give preference to positions in primary care, general surgery and other physician shortage specialties.

By Susan J. Landers — Posted May 28, 2009

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Bills have been introduced in the Senate and House of Representatives to reduce current and projected physician shortages by increasing the number of Medicare-supported residency positions.

The measures, both called the Resident Physician Shortage Reduction Act of 2009, would expand the number of positions by 15%. The increase would amount to about 15,000 additional residency slots, bringing the total to approximately 115,000, the bills' sponsors said.

Preference for the positions would be given to primary care, general surgery, nonhospital community-based settings and other areas of need, according to the legislation.

The measures also would change regulations to let residents train in nonhospital settings. And they would allow residency slots from closed hospitals to be used by nearby teaching hospitals so the slots are not lost, as is currently the case.

The bills lift a cap placed by the Balanced Budget Act of 1997 on the number of resident physicians each teaching hospital can claim for reimbursement under Medicare. Medicare does not generally reimburse such hospitals for training residents beyond the capped number of slots.

The AMA supports the bills. "Although medical schools are increasing their class sizes and several new allopathic medical schools and colleges of osteopathic medicine are scheduled to open within the next few years, Medicare-funded GME residency positions have not increased," AMA Executive Vice President and CEO Michael D. Maves, MD, MBA, wrote in a letter to Senate and House bill sponsors.

The Senate measure was introduced by Sens. Bill Nelson (D, Fla.) and Charles Schumer (D, N.Y.) and Majority Leader Harry Reid (D, Nev.). The companion House bill was filed by Reps. Joseph Crowley (D, N.Y.), Kendrick Meek (D, Fla.) and Kathy Castor (D, Fla.).

"No health care reform effort will be complete or even adequate unless we address the shortage of doctors in this country," Schumer said in a statement.

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