One of the mantras of medical malpractice tort reform advocates is that “frivolous” medical malpractice lawsuits and the lack of caps (limits) on damages that innocent victims of medical malpractice may recover for their injuries are driving physicians from their practices, leading to a shortage of physicians in some areas of the United States. Many predict that shortages of physicians will become more acute and more widespread under the Affordable Care Act because more people will be eligible for and will be seeking medical care.
In the 1980s and early 1990s, it was estimated that there would be a surplus of 75,000 physicians by 2000 and a surplus of 100,000 physicians by 2020. In 1997, based on erroneous projections regarding the number of physicians practicing in the United States, legislation was passed that capped the number of residency positions supported by Medicare.
While the health care work force doubled between 1990 and 2012 and the number of nurse practitioners and physician assistants increased five-fold during that period, the number of physicians grew by only 50%. The main restriction on increasing the number of physicians in the United States is the lack of enough residency training positions available throughout the United States — new medical school graduates need to obtain residency training in order for them to become licensed and to engage in the practice of medicine. As a result, it is predicted that the supply of physicians in the United States will remain flat for the foreseeable future due to the lack of enough residency training programs.
When the projected surplus of physicians did not happen by the late 1990s, osteopathic medical schools began to expand followed a few years later by the expansion of allopathic medical schools. As a result, it is estimated that there will be 50% more medical school graduates (more than 27,000) in 2020 than in 2000. However, there will be a bottleneck of required residency training available to the new physicians because the number of entry-level residency positions were capped for almost a decade.
If residency training programs had not been capped in 1997 and had the annual growth in the number of residency positions been allowed to increase at its historical rate, then there would be no present shortage of physicians in the United States.
Why is residency training considered so important in the United States (there is no requirement for completing a residency training program in order to become licensed in Britain, Canada, or Australia)? Because it is widely believed that successful completion of a residency training program assures that a level of quality has been achieved.
What are the current options to address the residency training bottleneck in the United States? More residency programs and more positions within existing residency programs could be funded (although there may not be enough hospitals to sponsor additional residency positions); the length of residency training programs in certain medical specialties could be shortened so that more residency positions would be available; and/or, physicians from outside the United States could be permitted to practice in the United States despite having no residency training (there would have to be other methods of assuring quality if residency training was not completed).
Source: JAMA, Viewpoint, November 13, 2013.
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