Medical Schools Target 30% Increase in Enrollment by 2019

Enrollment is on the rise, but lack of federally funded residency training positions is fueling concern among medical school deans about enrollment growth outpacing growth in graduate medical education.

The nation's medical schools are on track to reach targeted enrollment increases of nearly 30% within four years, but bottlenecks still exist with a shortage of clinical training sites and residency slots, the Association of American Medical Colleges says.

The AAMC's annual Medical School Enrollment Survey shows that first-year medical school enrollment in 2019–20 will reach 21,304—a 29.2% increase over the baseline enrollment level in 2002–03 and only 130 slots shy of the 30% target. The projections are in line with enrollment increases the AAMC called for in 2006.

"With the United States facing a shortage of up to 90,000 physicians by 2025, we are pleased to see our nation's medical schools increasing enrollment, both through the expansion of existing medical schools and the establishment of new ones," AAMC President/CEO Darrell G. Kirch, MD, said in prepared remarks.

"However, without an increase in federally funded residency training positions, all these new medical school graduates may not be able to complete their training and become practicing physicians," he added.

Medical school deans told AAMC in the survey that they were particularly concerned about the lagging number of clinical training opportunities for medical students and the bottleneck in residency slots that will be created with enrollment growth. In 2014, 87% of deans said they were alarmed by the number of clinical training sites and the supply of qualified primary care preceptors.

Similarly, 71% of schools reported "major or moderate concern" in their state about enrollment growth outpacing growth in graduate medical education.

Richard "Buz" Cooper, MD, a healthcare economist at the University of Pennsylvania, called the rising medical school enrollment "good news," but said that real issue was the lack of residency positions. "There is no enthusiasm among policy leaders or politicians to increase the numbers," Cooper says.

"They still believe that quality initiatives, reimbursement changes and the reorganization of practice into medical homes and Accountable Care Organizations with more involvement of nurse practitioners and physician assistants will solve the problem. It's a grand experiment in redesigning healthcare. I'm pessimistic that it will work."

The survey showed that two-thirds of the enrollment growth will be achieved by the 125 medical schools that were accredited as of 2002 if medical schools realize current enrollment projections for 2019. Newly accredited schools since 2002 will provide the remaining one-third of the growth.

Enrollment growth would be accelerated if any of the nine applicant schools in the Liaison Committee on Medical Education pipeline achieves preliminary accreditation. About 62% of the projected growth in enrollment by 2019 is expected to come from public medical schools, with 43% of the growth in Southern states, AAMC said.

Nearly three-in-four medical schools (72%) said they had or were planning at least one initiative to increase student interest in primary care, up from 49% in 2009, the survey said.

Congress Refiles Residency Bill
A bill backed by AAMC and other provider lobbies filed in Congress on Thursday would increase the number of residency slots by 15,000 over five years.

The Resident Physician Shortage Reduction Act of 2015 has been around since 2009, but has failed to generate sufficient support to become law.

Rick Pollack, executive vice president of the American Hospital Association, said Congress needs to expand the number of residency slots at teaching hospitals that have been "frozen for the last 18 years."

"The current freeze on the number of physician training positions that Medicare funds has severely limited hospitals' ability to train the next generation of physicians," Pollack said in prepared remarks. "It has also contributed to a shortage of physicians, especially in behavioral health, primary care and general surgery. The process of educating and training a physician can take up to a decade."

Residency training costs about $16 billion nationally, of which Medicare provides about $3.3 billion. It costs about $152,000 a year to train a physician, of which Medicaid pays $40,000.

Len Marquez, director of government relations at the AAMC, says the latest reincarnation of the bill has not been formally scored by the Congressional Budget Office, but a "back of the envelope" estimate puts the cost at about $10 billion over 10 years.

"This is the approach we have advocated for, a multi-step approach where you have continued development of new delivery models and a modest increase in the number of physicians you are training," Marquez says. "Hopefully you can marry these two things and you've got an ability to address that shortage."

Marquez concedes that there might not be much of an appetite in Congress to fund more healthcare programs just after lawmakers passed the sweeping – and expensive – repeal of the Sustainable Growth Rate funding formula.

"In the current budget environment it will be very challenging to move the bills," he says. "But there is bipartisan recognition that the physician workforce shortage is a problem that we need to address. So, that is what I am hopeful about, that we are able to generate bipartisan cosponsors."

Marquez says the bill has provisions that control where the residencies are allotted and what specialties get them.

"One of the things the bill wanted to get at was this notion of rewarding states that have made that investment in medical education," Marquez says. "For example, the first priority in these bills is hospitals that are located in states with new medical schools or branch campuses since 2001. In doing that you are lining up with the states and local governments and university systems that have made the commitment to graduate new medical students. It's not just the northeast. Now you are looking at Texas, Tennessee, Florida, Georgia, Louisiana, it really is spread across the country."

The bill also directs the 15-member National Healthcare Workforce Commission to determine which specialties are most in demand, and then sets aside half of the new residency slots for those specialties.

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