Editorial: Doctor shortage could be crippling to Congress’ plan for veterans

As part of its emergency reaction to the scandalous wait times at Veterans Affairs hospitals, the U.S. Senate passed a bill that includes $500 million to hire more health care workers. The question the bill left unanswered is: Where to find them?

The nation is facing a doctor shortage, particularly in primary care, that will persist unless Congress loosens the portion of the Medicare budget that finances graduate medical education.

During the past three years, primary care appointments have grown by 50 percent at VA facilities, but the roster of doctors has grown only 9 percent, the New York Times reports. As a result, caseloads have grown from 1,200 patients per doctor to as many as 2,000. Hence, the long waits.

The Senate has the right diagnosis, but Congress in 1997 capped the number of residency slots the federal government will finance at 26,000. Meantime, the population has grown, and grayed.

In short, demand is on the rise, and merely tossing more money into the VA budget won’t solve it.

The nation as a whole will need 91,500 more physicians – half in primary care – by 2020, according to the American Academy of Medical Colleges. Washington state will need about 1,700 primary care physicians by 2030.

Medical schools have responded by increasing enrollments, but students cannot become licensed physicians until they complete a residency program. It’s a challenge for medical education in Spokane.

Last year, Congress failed to pass the Resident Physician Shortage Reduction Act, which would’ve increased the number of residency slots by 15,000 over five years.

Congress needs to embrace that expansion, if members truly want to help veterans, and address the long-term need for more doctors overall.

However, the formula for allocating those slots also needs updating because it heavily favors the Northeast and ignores the migration of the population to the West and South.

A study published last June in Health Affairs revealed an appalling imbalance in how Medicare-funded residency slots are apportioned. New York, Massachusetts and Rhode Island had more funded positions than 31 other states combined. New York alone gets 20 percent of the funding, or 77 slots per 100,000 people. The national average is 35. Montana gets 1.6, Idaho 2.24 and Eastern Washington 6.8.

In another measure of disparity, Connecticut gets $155,000 per resident per year. Louisiana gets $64,000.

The Northeast isn’t experiencing a physician shortage, but the broken funding formula sends a vastly disproportionate number of medical students to finish up there. Studies show that students are more apt to take jobs near their residency assignments.

Meantime, Americans who have moved to the West and South have a hard time finding a doctor. Rural areas everywhere also are understaffed.

Meeting the growing demand for physicians will cost a lot of money. No way around that. But Congress must ensure that relief is located closer to the pain.