AMA meeting: Policies target doctor shortages, GME cuts

Honolulu With a massive physician shortage looming, the American Medical Association took several steps at its Interim Meeting aimed at expanding access to physician care in underserved areas and protecting the training pipeline from funding cuts.

The Assn. of American Medical Colleges estimates that there will be a shortage of 130,600 doctors by 2025, with half of the shortfall coming in primary care specialties. Already, doctors are in short supply in many rural and inner-city areas.

One attempt to address the latter shortages is the J-1 visa waiver program, which the House of Delegates said should be expanded. The program allots 30 positions in each state for international medical graduates who complete their graduate medical education and pledge to work two years in a Dept. of Health and Human Services-designated shortage area in exchange for waivers from the return-home visa requirement.

The house said the number of slots should be increased from 30 per state to 50, and directed the AMA to publish J-1 visa waiver statistics on its website. The AMA also will post a frequently-asked-questions document about the program, which state administrators say is underused because of onerous employer requirements and bureaucratic complexity.

Pediatric GME funding threatened

In addition, delegates directed the AMA to oppose cuts in federal funding for graduate medical education that would lead to the closure of residency programs or the dismissal of residents from current positions. Of particular concern to delegates was pediatric GME funding. Unlike adult residency slots that are funded through Medicare, pediatric residency funding must be approved annually by Congress.

Children’s hospitals train 40% of general pediatricians and 43% of pediatric specialists. The Children’s Hospitals Graduate Medical Education Payment Program was threatened with $48.5 million in funding cuts under President Obama’s proposed 2011 fiscal-year budget. The cuts were avoided, but the AMA ought to take a stand to protect existing residency slots, delegates said.

“If we were to lose these residency positions, or even a small portion of them, then how do we train these folks to become physicians?” asked Thomas K. McInerny, MD, a delegate for the American Academy of Pediatrics from Rochester, N.Y. “In pediatrics, in particular, our specialists are in short supply, so we’re worried that the last thing we need is fewer specialists for our children.”

The AMA already has policy opposing a 1997 cap on Medicare-funded residency positions, and favors expanding GME funding to meet physician work force needs. The house reaffirmed these policies in response to Interim Meeting resolutions regarding the shortages of practicing pediatricians and pediatric residency positions.