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Physician work force issues need attention

On a one-day visit to Spokane Thursday, the dean of the University of Washington Medical School brought a message that’s worth repeating.

And repeating.

In all the talk of health care reform, said Dr. Paul Ramsey, more attention needs to be paid to work force issues. He didn’t mean just that we need to train enough doctors, especially if expanded access to care suddenly increases the need for care providers. There’s more to it than raw numbers, and Ramsey underscored the fine points. We have to have the right mix of doctors (primary care providers are increasingly in demand), and we need to make sure they’re distributed where they’re needed, not just concentrated in the urban centers.

Those concerns are of specific significance in Spokane, where serious efforts are moving toward a four-year medical school, and to the surrounding rural region where a lack of doctors can be as much of a concern as a lack of health insurance, if not more.

Among other steps, Ramsey urges Congress to lift the cap that was imposed on medical school graduates’ residency placements more than a decade ago.

Residency is a three- to seven-year bridge from medical school to medical practice, and without enough opportunities the nation is going to find itself under-doctored.

“It is widely stated that the United States is not training a sufficient number of primary care physicians relative to nonprimary care physicians,” declared the U.S. General Accounting Office … 15 years ago. Shortly thereafter, Congress put a cap on the Medicare funding that had been the primary determinant of residency slots across the country.

The consequences are evident in a couple of recent forecasts. The Council of Graduate Medical Education predicted earlier this year that the nation faces a shortage of 85,000 physicians by 2020. Last year, the Association of American Medical Colleges estimated a shortage of at least 124,000 physicians by 2025.

Responding to a challenge of that magnitude will be impossible without an expansion of residency openings. And while individual hospitals have tried to fill some of the funding gap, there’s only so much they can do during an economic downturn that brings more charity-care expectations through their doors. State governments are in a similar bind.

The Medicare funding, which some advocates insist should be seen as patient care, was meant from the beginning to compensate the training hospitals for Medicare’s share of the costs. It’s time for the federal government to catch up from the lag that has resulted from the artificial lid on residency opportunities.

Ramsey notes that residency programs have an admirable record – better than for medical schools – of keeping their participants in the region where they receive their training. Which means that more residencies throughout Eastern Washington and North Idaho would give many of the region’s remote, underserved communities a better shot at attracting doctors.

The concern about having enough doctors is long-standing and well- documented. Lifting an artificial restriction on residency placements should be an element of any well- rounded health care reform effort.


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