IOM Report Questions Doc-Shortage Fears
By Christine Kern, contributing writer
The Institute of Medicine’s assertion that there is no imminent shortage of physicians has many in the industry crying foul.
The Institute of Medicine’s vision for overhauling Medicare-funded medical training is displeasing many physician organizations. The panel’s finding question two fundamental beliefs in healthcare: that a serious physician shortage is imminent, and that the only solution to the shortage is to infuse federal money into residency programs for training.
According to Dr. Darrell Kirch, president and CEO of the Association of American Medical Colleges while the AAMC does “appreciate the IOM committee’s recognition of the need for long-term, stable funding for training physicians as well as its vision of a health care system in which patients’ care is coordinated, comprehensive, and provided by highly competent and caring professionals. Medical schools and teaching hospitals are rapidly changing how and where physicians are trained to achieve those same goals,” the IOM committee's recommendations "would threaten the world's best training programs for health professionals and jeopardize patients," while slashing funding for level 1 trauma centers, pediatric intensive care units, and burn centers.
The IOM report – Graduate Medical Education That Meets the Nation's Health Needs – was written by former CMS administrators Dr. Donald Berwick and Gail Wilensky who said shortages result from poor geographic distribution of physicians and lopsided ratios of primary care and specialty physicians. Recent research demonstrates that solutions lie in the new technology and innovations in healthcare delivery.
"These studies suggest that an expanded primary care role for physician assistants and advanced practice registered nurses, redesign of care delivery and other innovations in healthcare delivery, such as telehealth and electronic communication, may ultimately lessen the demand for physicians despite the aging of the population or coverage expansions,” according to the report.
"The evidence instead suggests that while the capacity of the GME system has grown in recent years, it is not producing an increasing proportion of physicians who choose to practice primary care, to provide care to underserved populations, or to locate in rural or other underserved areas," the authors wrote.
The AAMC issued a news release declaring that the "IOM's vision of GME will not meet real-world patient needs."
To correct the imbalance of residency positions, with disproportionately high numbers in New York, New Jersey, and Massachusetts, the report recommends the creation of an HHS GME Policy Council similar to the Medicare Payment Advisory Commission, which would develop policy for geographic distribution and specialty configuration of the physician workforce.
The report also recommends moving more programs out of academic medical centers and into community clinic settings. The American Hospital Association said this was already being done and disagreed with the direction of the report.
A coalition of 20 surgical specialty societies acknowledged the geographic maldistribution but disputed the suggestion that new Medicare-funded residency positions aren't the answer. "At a minimum, Congress should bolster the U.S. surgical workforce by lifting the cap on the number of federally supported residency training positions and adopting legislation to increase the number of Medicare-supported residency positions," the Surgical Coalition said in a statement.
The coalition also said that the nation faces a shortage of 64,800 surgeons and other specialists plus 65,800 primary-care physicians by 2025.
The American Medical Association, meanwhile, projects shortages of 45,000 primary-care doctors and 46,000 specialists by 2020 and likewise argues Medicare should fund more residency slots "to produce an appropriately sized and geographically distributed physician workforce."