That didn't happen. "The cap," Grover writes, "is still in place, limiting teaching hospitals' efforts to expand or create new programs." Medicare now pays for less than 25% of direct training costs for residents and fellows.
In the late 1990s, when Grover was a resident, there were HMOs, and predictions for the need for physicians were less dire. Then "technology helped make fatal diseases chronic diseases," he says. Now Congress needs to expand the number of federally supported residency positions, he says, noting that some legislation has been proposed.
Grover agrees with healthcare planning providing for physician assistants, social workers, nurses, physical therapists, and pharmacists to buttress physician work. But that only goes so far without physicians themselves, he says.
Even if current health care delivery reforms are implemented and successful, the U.S. population certainly will need a larger healthcare workforce, including more physicians. The Patient Protection and Affordable Care Act may add up to 30 million more insured to the population in the upcoming years
"I worry about giving 30 million people a card and a false promise," Grover says.