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Medical School Enrollment Forecast Tempered by Residency Concerns

 |  By John Commins  
   May 06, 2013

Medical schools will boost enrollment 30% by 2017 to ease the nation's physician shortage, but that won't do much good if the federal government won't provide funding to expand residency slots, a new survey of the nation's medical school deans finds.

"Our medical schools have fulfilled their commitment toward taking the first step in addressing the physician shortage," says Christiane Mitchell, director of federal affairs for the Association of American Medical Schools. "Now we have to ask Congress to help us take the second step to make sure all of those new medical school graduates have a residency training position."

The 9th annual Medical School Enrollment Survey from the AAMC's Center for Workforce Studies found that first-year medical school enrollment is projected to reach 21,434 in 2017-18—a 30% increase above first-year enrollment in 2002-03, the baseline year used to calculate the enrollment increases that the AAMC called for in 2006.

In the survey, however, 40% of the medical school deans expressed "major concern" about enrollment growth outpacing growth in the number of available residency training positions. The 2013 annual match of medical school graduates with residency slots was only the second time there were more unmatched U.S. seniors than unfilled positions; the first time was 2010.

The insufficient number of residency slots means that some unlucky medical school seniors will graduate deeply mired in student loan debts but with nowhere to go. " You cannot practice medicine in the U.S. unless you complete a US residency training program," Mitchell says. "In fact, this year already we started to see a few students not match to residency position because there simply weren't enough."

The cost of medical residencies varies greatly depending upon the specialty, but Mitchell says the "back of the envelope" average is about $150,000 per residency slot. AAMC has recommended a 15% increase in the number of residency slots over the next decade, which would cost about $9 billion.

Unfortunately, Mitchell says, there is little support for the funding among federal elected officials.

"It is going to be an enormous challenge," she says. "In fact what we worry about most of all now is that not only are Congress and the White House not very interested in spending more money on graduate medical education, all of their deficit reduction proposals, Republicans and Democrats, Congress and the White House, have all put in cuts in current support. It is contradictory to efforts to make sure that there are enough doctors for Medicare beneficiaries and all of the folks who are getting coverage under healthcare reform. It's not consistent."

A breakdown of the survey found that 62% of the enrollment growth will occur in the 125 medical schools that were accredited as of 2002, 31% will occur in schools accredited since 2002, and 7% will come from schools that are currently applicant or candidate schools with the Liaison Committee on Medical Education. Fifty-five percent of the 4,946 new positions projected by 2017 are expected to come from public medical schools, with the greatest growth occurring in the South, where schools account for a 46% of the increase between 2002 and 2017.

Even with the challenges of funding and little support from Washington, D.C., Mitchell says medical schools are encouraging students to gravitate towards primary care, especially in this new era of payment and care delivery reforms.

"If you look at the payment changes that were made under the Affordable Care Act, even Medicare has realized that they are not paying primary care adequately so they are saying 'we value primary care and we need to put our money where our mouth is,'" Mitchell says.

"The [PPACA] has started that process and there is going to be an ongoing look at how they can insure that primary care physicians are being reimbursed fairly."

"The other thing is that we have this new evolving delivery system that emphasizes accountability. You have an accountable care organization or a patient-centered medical home," she says. "Primary care physicians have the opportunity to be not just leaders in this new model of delivering care but ultimately they are at the center of that delivery system."

"You do see a growing interest among medical students in a primary care career because they view it as a new role and purpose and a new stature associated with these new delivery models and that is improving the attractiveness of the primary care career. But you also have to remember that the new generation of physicians is also looking carefully to ensure their work and personal life are in balance and a primary care career can challenge that balance. It's money and personal perspectives and professional evolution all in play."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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