Medical student enrollment has increased across the country, but the Association of American Medical Colleges estimates by 2030 the United States could see a shortage of up to 120,000 physicians. So, what’s causing it to happen?
“The bottleneck now is that medical students are graduating with an MD degree, and they have to do a residency to practice and those slots have been frozen,” said Dr. John Poole, Medical Society of New Jersey president.
The Balanced Budget Act of 1997 capped the amount of Medicare funding for graduate medical education.
“The federal government helps sponsor residency programs, so they help pay residents’ salaries,” said Dr. Jeffrey Boscamp, senior vice president of medical school development at Hackensack Meridian School of Medicine at Seton Hall University. “The cap for a lot of hospitals in New Jersey just isn’t high enough for what we need.”
Boscamp says you have to remember the funding guidelines were put in place over 20 years ago.
“New Jersey has not had that many residency spots because New Jersey wasn’t a medical destination in the 90s the way it is today, so there was never any adjustment to reflect the amount of education that we’re doing,” said Boscamp.
Poole says that means students are graduating from medical school, but they’re not able to find a residency spot in the state, causing them to leave. And once they leave, statistically they’re not likely to come back.
“About 80 percent of people, where they finish their training is where they end up going into practice,” said Boscamp.
At the same time, the AAMC says one-third of all currently active doctors in the country will be older than 65 in the next decade. The result: a potentially critical shortage of doctors in the United States. And In New Jersey?
“Some estimates state that we need perhaps 2,500 new doctors by 2020 moving forward,” said Rep. Leonard Lance. “And of course the baby boom generation is retiring and is going to need significant medical care over the next 25 years or so.”
Lance is a co-sponsor on a bipartisan bill that was introduced to the House by Rep. Josh Gottheimer.
It says it corrects the outdated law that locked some hospitals out of residency training slots they were entitled to because some students were out on rotation and that wasn’t factored in in 1996.
New Jersey Sens. Cory Booker and Bob Menendez recently introduced companion legislation in the Senate.
“There are whole areas that we have shortages of in this state and it doesn’t make sense,” Booker said.
There’s another bill also looking to fix the shortage by expanding federal funding to add 3,000 new residency positions across the country each year over the next five years to fix the cap.
“One solution might be an all payer solution. Why should only Medicare or the government fund residency? We all benefit from having more physicians,” Poole said.
“Hackensack and Meridian is so committed that we’re actually well above the cap. We have a lot of residents that we pay for ourselves,” Boscamp said.
The trend of taking it into your own hands is also happening on campuses like New York University’s School of Medicine. They recently announced they would pay the tuition of all its current and future students to ease financial debt. It’s a solution Poole says is necessary to help keep doctors in the Garden State.
“The average medical student graduates with almost $200,000 of debt from medical school. If you think about it, you’re going to come to Bergen County and you’re going to start a family, maybe you’re planning to start a family, you want to buy a house within commuting distance of the hospital. It’s high taxes. It’s just a high-cost state,” Poole said. “There’s issues with malpractice reform. The word’s out there.”
The co-chief executive officer at Hackensack Meridian Health says schools like this one will be part of the solution. They’re offering a three-year program as a way to keep students in the state.
“Number one, it will save those students the fourth year of tuition, which is significant because affordability in medical education is definitely an issue out there. But in addition to that, it gives them a secure residency slot, if you will, at a Hackensack Meridian site,” said Robert Garrett, co-CEO of Hackensack Meridian Health.
Essentially creating their own pipeline for students to train and to stay here.