Medical students urge Congress to preserve GME

Washington Hans T. Zuckerman, a third-year medical student at the Philadelphia College of Osteopathic Medicine, painted a grim picture of what may await future students like him if federal support for graduate medical education either is reduced or not expanded.

“In the next couple of years, they're projecting that there may not be enough slots for all the students graduating from medical school to get into a residency,” said Zuckerman, who was one of about 300 medical students from around the country who participated in the American Medical Association's student advocacy day on Feb. 11. The medical students met with members of Congress during the event to urge lawmakers to preserve Medicare funding for residencies and take additional steps to boost the number of Medicare-supported residency positions.

Graduate medical education funds often have been the target for cuts during congressional budget negotiations. There's concern throughout organized medicine that talks regarding the automatic budget cuts, which are set to take effect on March 1 through a process known as sequestration, will hurt these programs. A 1997 cap on Medicare-funded residency slots has created additional problems; according to the AMA, medical school graduates in the U.S. will exceed the number of available slots as early as 2015.

“Residency training gives new physicians hands-on experience and provides high-quality care to patients,” said AMA President Jeremy A. Lazarus, MD, in a statement. “Limiting the slots available to train physicians as they leave medical school creates a bottleneck in the system and prevents the physician work force from growing to meet the needs of our nation's patients.”

Residency spots in doubt

There's a very real possibility that by 2015 some in the class of students graduating with medical and osteopathic degrees won't be able to get into residency slots, Zuckerman said. Many of these graduates will have hundreds of thousands of dollars in student loans but no jobs to help make payments, “or they'll have to choose lower jobs or find work anywhere they can. But they won't be able to practice medicine,” he said.

Compounding the problem is the fact that more medical school programs have been opening as residency programs shrink. “A lot more different fields have gotten competitive, even the less competitive fields” such as family medicine, said Leonid Vydro, a fourth-year medical student at the Medical College of Wisconsin in Milwaukee. As a result, “it's harder to get into programs into a lot of areas, including some that are really quite underserved.”

Everyone agrees that GME funding is an important issue, “but it all comes down to money and politics,” Zuckerman said. “A lot of times Republicans and Democrats will agree on an issue, but they won't be able to agree on how to fund it. And it's never popular to increase Medicare funding.” For that reason, Zuckerman said he would like to see federal GME funding delinked from Medicare.

The AMA recently took steps to preserve funding for GME programs, approving policy at its Interim Meeting in November 2012 to oppose GME cuts that would close residency programs or dismiss residents from current positions. To prepare for the Affordable Care Act's 2014 coverage expansions, the AMA policy supports campaigns to boost the number of residency positions by at least 15%.

A medical education remains a costly venture. Andrew Rudawsky, a third-year medical student at the University of Toledo College of Medicine in Ohio, estimates that his total debt, including undergraduate education costs, may end up amounting to $300,000.

“It's a significant number, and in considering what type of medicine I'd like to practice in the future, I'd really like to have a family and own a house and pay for my children's education. That's difficult to do if you're entering a low-paying primary care specialty. But, unfortunately, it's the area that we have the greatest need for,” Rudawsky said. He has yet to decide whether to go into a primary care or surgical field.