By Drew Lee, MD, MA
Like millions of Americans, I was born into a family of modest means. My parents both immigrated to this country with little more in their pockets than a dream for a better future. Though they could not always provide me with everything that I needed, their encouragement of my educational endeavors knew no limits. My parents always told me that if I studied hard enough, I could become anything I wanted, especially a doctor! When I entered college, my parents could not support my education and I found myself working three part-time jobs to pay for tuition. I was exhausted, burned out, and discouraged, and informed my parents that I would be dropping out of college. Thankfully, however, I did not.
The financial struggle I faced in pursuit of higher education is not unique to me but shared by millions of young Americans. Somehow, I was fortunate enough to make it into medical school, but when I entered in 2008, my parents’ income was closer to the bottom five percent compared to most of those in the matriculating class.
With the proposed 10-year, $10 billion graduate medical education (GME) funding cuts that are on the horizon — through Congressional efforts or automatically via sequestration — I cannot help but wonder what it’ll mean for residency programs, medicine, and primary care in this country. First, the proposed GME funding cuts could eliminate 33 percent of residency positions, forcing many medical school graduates to put their training on hold or seek alternative sources of funding to complete their graduate medical education.
Second, with a predicted shortage of 90,000 physicians by 2020, GME cuts will likely add to that physician deficit and put a greater strain on the medical infrastructure.Ultimately, the people who will suffer the most from these cuts will be patients, who will have longer wait times or longer distances to travel in order to receive the vital medical care they need.
Third, GME cuts are likely to hit primary care training and physician output in this country, especially as these residencies do not generate as much revenue as other specialties under our current reimbursement structure.
Coming from a socioeconomically disadvantaged background, I am concerned that GME funding cuts will pose another hurdle for me to overcome in achieving my dream of becoming a physician advocate for the medically underserved. Does it mean that I’ll have to take out another loan or find additional work to pay my way through residency? Does it mean that the family medicine residencies or the spots I am currently applying to will no longer be available next year? A 2003 study by Sanf et al. suggests that physicians-in-training from lower socioeconomic backgrounds are more likely to pursue a career in primary care, at least in family medicine. Will GME funding cuts further push students away from primary care?
Many questions remain unanswered. Depending on how the actual GME funding cuts play out, there might be devastating consequences regardless of what health care reforms are implemented — not only for primary care, but for the future of health care in this country.