Since the 1990s, many changes have occurred in healthcare. HIV infection is no longer a presumptive death penalty, minimally invasive robotic technologies have redefined a range of surgical procedures, and telemedicine has greatly expanded access to treatment. So why, in the face of such remarkable progress and change, has the number of doctors the United States produces each year not changed enough to meet the evolving needs of our population? The answer is Congress.
There is only one path a medical student can take to become a fully licensed physician. It’s a residency. With an estimated 82% of federal funding sustaining most of our residency programs in 2018, the federal budget has a direct and terrifyingly limiting impact on the number of doctors the United States produces. This federal bottleneck is primarily due to the Balanced Budget Act of 1997, which limited the number of federally funded residency spots to 100,000. Since then, the only increase is the 2021 plan to add just 1,000 residency spots (in phases over five years). For context, this is his 1% increase in his 24 years. At the same time, the US population has grown 22%, and medical school enrollment has increased 37.5% since 2002, according to the American Association of Medical Colleges (AAMC). Not due to necessity or a shortage of medical school students, but due to a shortage of federally funded residencies.
For the average American patient, this is another barrier to getting much-needed medical services. The simple fact is that there is no medicine without doctors. Fewer doctors per capita means fewer patients can be treated, and therefore less time per patient.
Physician needs in specific specialties or in specific geographies may vary, but for the United States as a whole, physician shortages are just beginning. AAMC reports predict that by 2034 there will be a shortfall of 37,800 to 124,000 doctors. More than two of her five U.S. doctors will be over the age of 65 within the next 10 years, so there is a growing elderly Medicare population who need more specialized care than ever before. increase. With a younger population increasingly in need of mental health services and a general increase in the total population, the growing demand for doctors cannot be ignored.
The COVID-19 pandemic in particular has underscored, more than ever before, the importance and strain placed on doctors and other healthcare workers. Hospitals across the country have been understaffed and overstaffed in waves over the past few years. According to a Mayo Clinic publication, 62.8% of doctors said he showed one or more signs of burnout in 2021, compared with 38.2% of his doctors in 2020 reported an increase in depression and a decrease in satisfaction with his work-life balance. The specific challenges of the pandemic may be unique, but this test of our fortitude is just one part of the true crisis yet to come.
This predicament also raises the question: Why has little changed in over 20 years? The answer is complex. The general consensus in Congress in 1997 was that failure to limit the number of residency spots would result in an oversupply of doctors and an overcharge on the Medicare budget. However, the current medical reality is markedly different. Nevertheless, continued budget concerns, lack of broad congressional support, and lack of public awareness of the issue have all played a significant role in hindering progress. With less than 10% passed in the last Congress (2019-2021) and healthcare spending focused on COVID-19-related research, testing and financial assistance, it is not surprising that residencies will expand significantly . The funding change was difficult.
However, this lack of funding does not mean that efforts have not been made. Behind the scenes, former Senator Bill Nelson (D-Florida), former Congressman Joseph Crowley (DN.Y.), and several others have repeatedly tried to pass legislation that would significantly raise the residency limit. did. Amazingly, between 2007 and 2019 he had eight bills proposed and rejected. The latest bill, introduced in March 2021 and sponsored by Senator Robert Menendez (DN.J.), is known as the Reducing Resident Doctor Shortage Act of 2021. He also aims to add 14,000 federally funded residency spots in his seven years. An increase of 14,000 spots may be too small to be a panacea for the doctor shortage, but passing this bill would be a sizable first step. Adding more residencies or removing the residency limit altogether could ultimately have a greater impact, but legislative progress is often gradual.
While the failure to pass meaningful legislation may paint a rather bleak picture on the surface, the COVID-19 pandemic has made Law vs. Wade, and now, with the surge in respiratory syncytial virus (RSV) in children, healthcare is arguably in the public eye. With the issue evolving gradually (between adding 1,000 resident spots and proposing more legislation), Congress may finally be poised to make meaningful changes. Without it, we risk failing to remedy the growing crisis of our own creation: the epidemic of doctor shortages.
Christian Hardoy is a sophomore at the UC Irvine School of Medicine with an interest in health policy and an active involvement in medical education research, student mentoring, anemia research, and geriatrics.
