Increasing Primary Care Residency Positions Critical to Alleviating Physician Shortages, Says AAMC

The Association of American Medical Colleges (AAMC) is calling for the enactment of four core recommendations to increase the number of U.S. physicians and alleviate a growing physician shortage that is projected to get worse as a result of an aging population and expanded health care coverage. This includes a recommendation to increase the number of primary care residency positions.

"This is the first time the AAMC has explicitly promoted the need for increasing the number of primary care residency positions," says AAFP President Jeffrey Cain, M.D., of Denver. "As an Academy, we are very pleased about that."

In a recently released white paper (5-page PDF; About PDFs) outlining its workforce policy recommendations, the AAMC says the Supreme Court decision in June upholding nearly all of the provisions of the Patient Protection and Affordable Care Act has "significant implications for the physician workforce, as an estimated 32 million Americans may become newly insured under the (Affordable Care Act)."

"Additionally, 10,000 Americans turn 65 daily and will continue to do so for the next two decades," says the AAMC. "As these individuals gain coverage through private insurance and Medicare, the United States is projected to confront a shortage of 91,500 doctors by 2020."

The AAMC stresses that "the United States cannot afford to wait until the physician shortage takes full effect because by then, it will be too late."

"We must be proactive and remember that the education and training of a physician takes more than a decade."

The AAMC says its recommendations "are intended to ensure that policymakers understand that an adequate supply of physicians must be achieved through more efficient health care delivery models and by increasing physician training positions."

"No single approach is sufficient -- all of the following are necessary to ensure an adequate supply of physicians," says the AAMC.

The recommendations are that

Although the AAFP is pleased about the AAMC's call for more primary care residency positions, it has some concerns about the AAMC's position paper, Cain says. For example, the AAMC says that about half of medical school graduates go into primary care, a statement that is "just not accurate," according to Cain.

"It is much lower than that," he adds.

In fact, the majority of medical school graduates who enter primary care internal medicine and pediatric residency tracks go on to train in subspecialty residencies and never actually practice primary care, Cain notes.

"We know that the highest quality and lowest cost health care system for our country will require a workforce of 40 to 50 percent primary care," says Cain, pointing out that the Council on Graduate Medical Education has said primary care physicians should make up at least 40 percent of the nation's physician workforce. It is imperative that at least half of medical school graduates succeed in ultimately practicing primary care, says Cain.

According to him, AAFP members should view the AAMC's recommendations with cautious optimism. "We need to help the AAMC shape their policy into legislation that works for our medical schools and for the public," says Cain.

The AAMC recommendations are a follow-up to a 2006 AAMC statement on physician workforce that included a recommendation to expand U.S. medical school enrollment by 30 percent from 2002 levels.

"Medical schools are on track to meet that 30 percent goal by 2016, but residency training … positions have increased only by 8 percent since 2002," the AAMC says. "The expansion of medical schools is an imperative step toward creating an adequate supply of physicians, but the limited availability of residency positions means that new physicians may not be able to secure residency training, a prerequisite for independent practice."

The AAMC also addresses caps on physician training, pointing out, for example, that the Balanced Budget Act of 1997 capped Medicare-funded GME at 1996 levels "for almost all teaching hospitals and continues to limit teaching hospital efforts to expand or create new programs."

The health care reform act "did not eliminate the cap but allowed for the training of approximately 300 additional physicians a year -- far fewer than 10,000 additional physicians the nation would need to train annually to address the entire physician shortage," says the AAMC.

"Unless Congress increases the 1997 cap on the number of residency positions for which Medicare pays its share of the costs, the number of physicians per capita will decrease."