The “Me” in GME

By Atul Grover, MD

Originally posted as a Second Opinion on the AAMC website, October 24, 2013

Medical school enrollment statistics released today indicate an all-time high in applicants and enrollees to the country’s medical schools this year, with a 21.6 percent increase since 2002. The last time medical schools received so many applications was in 1996, just before Congress imposed a cap on Medicare support for graduate medical education (GME), the required next step in medical graduates’ training before they can practice independently.

The country needs more doctors. We’re facing a shortage of 90,000 by 2020. Students are doing their part to alleviate this shortfall by applying to medical school in record numbers. Medical schools are doing their part by expanding enrollment and graduating more M.D.s. Now Congress and the administration need to do their part and support growth in training rather than proposing cuts. The first crucial step is to lift the cap on federally supported GME positions so that doctors can complete training and serve their communities. While it’s easy to understand the consequences of this bottleneck for patients seeking a physician’s care, I want to share with you a fourth-year University of South Florida medical student’s concern about her future in medicine.

– Atul Grover, MD

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Reaching the end of my journey in medical school, I often reflect on my progression of knowledge, not just in the science of medicine, but also in that of policy. When I started school, I couldn’t explain the difference between Medicare and Medicaid. Several years later, I found myself anxiously awaiting the ruling on perhaps the most significant decision of a Supreme Court in my lifetime and was shocked as a classmate asked, “What’s the ACA?” (I suppose for many medical students “ACA” means “anterior cerebral artery.”) I realized I had a new interest in health care policy. And the issue I am most passionate about is the GME crisis.

Each year on Match Day, students open envelopes to find out which residency program they will be entering. The number of students in last year’s Match that didn’t get a position doubled from the prior year. These people aren’t numbers, they are my friends. And in five months and with the worst odds ever of matching, I wonder . . . could this be me?

While medical students live busy lives absorbed in their studies, we have started paying attention to policy decisions that may affect our futures. Things hit a little closer to home on Match Day last year. When you see someone you know not get that special envelope, it sends a strong warning signal that your hopes and dreams to practice medicine could be in jeopardy.

Since 2006, when the AAMC called for a 30 percent increase in medical school enrollment to address the impending physician shortage, five new medical schools have opened in my own state of Florida. Four existing medical schools have expanded their classes.

Unfortunately, Florida has fewer first-year GME positions than graduating medical students today, meaning that despite state funding to support an impending shortage of physicians, we are exporting the very students in which we invested. In both Florida and across the country, delays in expanding physician training will have widespread implications.

We need more of every type of doctor. And we have students who are ready to meet these needs. We should encourage students’ zeal for their particular fields to guide their career, be it in pediatrics, cardiology, or plastic/reconstructive surgery, and we should ensure that we are supporting the training infrastructure for students to realize those aspirations.

Solving the physician shortage crisis will involve multiple and sometimes complex solutions. First and foremost, we must protect funding for our residency training programs, as our existing programs simply will not survive with further cuts to government funding. Proposals to cut GME funding even threaten my friends who recently matched—they could lose their positions, leaving them severely in debt and unable to complete their training. Second, we need to actually expand the number of residency positions so our medical students can go on to fill the shortage of physicians in our nation.

Let’s hope Congress will act. In the meantime, my fingers and toes are crossed for March 21, 2014—not that I am counting or anything!

Alicia Billington is an M.D.-Ph.D. candidate at the University of South Florida Morsani College of Medicine.

Learn more about graduate medical education and the physician shortage.

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