Lift cap on medical education placements

As 2009 ended, so did the work of two committees that spent the past several months on a proposal for expanding medical education in Spokane. Their final report contained no surprises when it was turned in this week, but it did underscore a serious need for residency placements for medical school graduates.

It’s been a dozen years since Congress imposed a cap on the graduate medical education it funds through Medicare payments to hospitals. In places like Spokane, that means hospitals themselves and state government have picked up the slack. But those resources are even more strained than the federal government’s.

Meanwhile, the nation, Spokane and Eastern Washington included, faces a troublesome physician shortage, especially in the primary care fields that are critical in rural areas. That shortage could get even worse if federal legislation expands health care access as expected.

Even without increased demand, though, a current physician shortage has been documented, and it weighs heavily on Washington state in general and the Spokane region in particular. This state traditionally attracts about 80 percent of its medical doctors from elsewhere – and “elsewhere” is doing more and more to keep its medical graduates at home in the face of the nationwide shortage.

In other words, Washington is going to have to produce and retain more physicians to meet its own demands. Washington isn’t alone, of course.

For nearly 40 years, a highly regarded collaboration involving Washington, Idaho, Montana, Wyoming and Alaska has relied on the University of Washington School of Medicine to provide regional medical education for the mostly rural, five-state area. The need to grow that program, including development of a four-year medical school in Spokane’s University District, has been recognized and is in the cards.

But among the issues that must be solved for that plan to succeed is where medical school graduates will go for the residency programs that prepare them to go into practice and serve their communities. Until a few weeks ago, the U.S. Senate’s health care reform bill included a provision lifting the cap on graduate medical education placements. Regrettably, it was removed. Unless Congress finds a way to restore it, a vital element in any strategy to address the physician shortage will be missing.