Tillis introduces policy proposal to improve medicare physician training

Sen. Thom Tillis and six of his bipartisan colleagues in the Senate Finance Committee outlined a policy proposal last week proposing improvements to the Medicare Graduate Medical Education (GME) Program. 

The proposal targets physician shortages across the country, mainly in primary care and psychiatry and focused in rural and underserved communities.

“It has become clear that there are not enough physicians to meet the health care needs of Americans,” the senators wrote in a press release. “As a bipartisan group of members of the Senate Finance Committee, which has jurisdiction over the Medicare Graduate Medical Education program, we are interested in advancing additional Medicare GME proposals to address health care workforce shortages and gaps.”   

In 1996, due to concerns of an oversupply of physicians, Congress capped the amount of Medicare GME funding a teaching hospital could receive based on the number of training residents at that hospital. Fast-forward 30 years and there are not enough physicians to meet the health needs of Americans. Current projections indicate an anticipated shortage of 139,940 physicians across all specialties by 2036, including 68,020 primary care doctors and 42,130 psychiatrists in the same time frame according to the Health Resources and Services Administration (HRSA). 

“Congress can act to address these shortages by increasing the number of Medicare-supported residency positions in teaching hospitals,” according to the proposal. “In addition, federal Medicare GME legislation can address the disproportionate shortage of physicians in certain specialties, including primary care and psychiatry, and in certain geographic locations, such as rural and underserved communities. Finally, improvements to the federal Medicare GME data collection can improve the use of this program to sustain the health care workforce long-term.”  

The American Association of Medical Colleges (AAMC) reports enrollment numbers for Duke University, ECU Brody, UNC-Chapel Hill and Wake Forest for the last five academic years, beginning with 2019-2020. For the academic year 2023-2024 the total enrollment number for all four schools only 2,428.

For 2022, the Tar Heel State only had 7.42 primary care physicians per 10,000 residents, approximately 7,000 in total, according to the North Carolina Professional Supply Data. For the same calendar year, numbers for psychiatrists were much lower at a state rate of 1.41 psychiatrists per 10,000 residents, and just over 1500 total.

Last year, Forbes ranked North Carolina the third worst state for healthcare, and the worst for overall healthcare costs.

As with any market, economic laws of supply and demand are at play, and North Carolina still suffers under a Certificate of Need (CON) regime that artificially limits supply of healthcare services and facilities and increases costs in the state.