IOM's medical education study casts doubt on pending physician shortage

The Institute of Medicine (IOM) has issued a report outlining their vision for overhauling Medicare-funded graduate medical education (GME) but the industry is abuzz over some of the recommendations.

Written by former CMS administrators Donald Berwick, MD, and Gail Wilensky, PhD, the report says shortages are created by poor geographic distribution of physicians and uneven ratios of primary care and specialty physicians. They cite research that indicates new technology and innovations in healthcare delivery could solve the problem.

"These studies suggest that an expanded primary care role for physician assistants and advanced practice registered nurses, redesign of care delivery and other innovations in healthcare delivery, such as telehealth and electronic communication, may ultimately lessen the demand for physicians despite the aging of the population or coverage expansions," they wrote.

Medicare-funded residency positions have been capped since 1997, but the report noted that a 17.5 percent increase in training slots in the last 10 years due to funding by other sources has not eased geographic shortages or improved the specialist mix.

"The evidence instead suggests that while the capacity of the GME system has grown in recent years, it is not producing an increasing proportion of physicians who choose to practice primary care, to provide care to underserved populations, or to locate in rural or other underserved areas," the authors wrote.

"The IOM’s proposal to radically overhaul [GME] and make major cuts to patient care would threaten the world’s best training programs for health professionals and jeopardize patients, particularly those who are the most medically vulnerable," said Association of American Medical Colleges President and CEO Darrell G. Kirch, MD. "The committee’s proposals assume that in the coming decades, our healthcare workforce would require no expansion of the highly specialized services or physicians equipped to meet the needs of a growing and aging population, with ever greater need for both primary and specialty healthcare."

Kirch said the proposal to reduce as much as 35 percent in payments to teaching hospitals "will slash funding for vital care and services available almost exclusively at teaching hospitals, including Level 1 trauma centers, pediatric intensive care units, burn centers, and access to clinical trials." The cuts also will limit critical training settings. 

"While the current system is far from perfect, the IOM’s proposed wholesale dismantling of our nation’s graduate medical education system will have significant negative impact on the future of healthcare. This is hardly the moment to use economic theory to experiment on a system that is integral to maintaining the health of all Americans.”

Access the report: Graduate Medical Education That Meets the Nation's Health Needs.