Opinion | An Upstream Solution to the Physician Shortage

On March 18, Senator Bob Menendez (D-N.J.) introduced the Resident Physician Shortage Reduction Act of 2021. This bill has not received the attention nor the fanfare of other pieces of legislation like the infrastructure deal, and whether it even has a path forward remains to be seen. However, this bill seeks to address the looming physician shortage that our nation as a whole will soon face — and that many parts of the country are already experiencing. As two emergency medicine physicians, we are here to emphasize that this bill is badly needed to fix our ailing healthcare system.

The coronavirus pandemic has brought renewed attention to the severe staffing shortages affecting all levels of the medical system. Throughout the pandemic, hospitals around the country have struggled to meet basic staffing needs — but concerns over physician shortages existed well before the pandemic began. According to a report released by the Association of American Medical Colleges (AAMC), there was a total of 938,980 actively practicing physicians in the U.S. in 2019, equating to 353 patients per physician. The pandemic has not improved the situation. In June of this year, AAMC released data projecting an estimated shortage of between 37,800 and 124,000 physicians by 2034. This shortage impacts physicians of all types, from specialists to primary care physicians, equally.

Yet, as dire as the physician shortage is projected to be, it will disproportionately affect rural America. The healthcare situation in rural areas is already bleak, with the federal government designating nearly 80% of rural America as “medically underserved.” And the situation is only going to worsen: health officials predict the number of doctors working in rural parts of the country will decline by 23% over the next decade.

One of the many factors driving this physician shortage is the number of residency training spots. After graduation from medical school, newly minted doctors are required to complete a residency in their chosen medical specialty before they can obtain a medical license and practice independently. A physician’s residency can be anywhere from 3 to 7 years depending on the specialty. Although hospitals are responsible for providing this structured training, residents’ salaries and expenses are actually paid for by the federal government. CMS is responsible for the allocation of funds to hospitals for resident training.

CMS tightly regulates the number of training positions available through the distribution of funds. The Balanced Budget Act of 1997 capped the number of residency positions CMS would fund, and in the nearly 2.5 decades since then, the number of residents has only grown by 27%. Many of these positions are not funded by CMS, and unfortunately, the number of residency positions has not increased to keep pace with the expanding and rapidly aging population.

This has created a bottleneck on the number of physicians available to the workforce. Medical schools are expanding class sizes in an attempt to head off the looming physician shortage. But without a concurrent increase in the number of residency positions, the physician workforce will remain woefully understaffed.

Senator Menendez’s bill seeks to address this. The Resident Physician Shortage Reduction Act (S.834) would “increase the number of residency positions eligible for graduate medical education payments under Medicare for qualifying hospitals, including hospitals in rural areas and health professional shortage areas.”

The benefits of this bill are obvious — allocating more funding towards the training of future doctors leads to a decrease in the current and future national physician shortage. However, some argue this bill has no instant gratification; we would not reap the benefits until well into the upcoming decade. Others argue that proposing more government spending is irresponsible, with the government already facing such a large deficit. But this bill is not intended to be a quick fix for such a large-scale issue. And in part due to the lengthy training to become a board-certified physician (at minimum 7 years including medical school), this process will require time and investment. But it’s a worthwhile and much-needed investment in the long-term health of our country.

The COVID-19 pandemic has changed the world of healthcare in indescribable ways. And it has highlighted our need for more physicians everywhere but most notably in rural areas. Statistics, especially from the peak of the pandemic, consistently show that patients in rural America and minorities are dying from COVID-19 at a faster rate than urban city residents and white Americans. Of course, many factors have contributed to these disparities. But no one should die due to a lack of physicians.

The Resident Physician Shortage Reduction Act can aid us in our pursuit of providing the quality, equitable healthcare that we desperately need. Our country is full of medical students who went into a career in medicine because of their desire to help others — we should be giving them the opportunity and funding to do just that.

Gregory Jasani, MD, is an emergency medicine physician with the University of Maryland School of Medicine in Baltimore. Rebecca Fenderson, MD, is an emergency medicine resident physician at Cooper Medical Center in Camden, New Jersey.

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