• drewjdavis

The U.S. needs more doctors. It might finally start training them.

Updated: Aug 15


Healthcare access can be a life-or-death issue in much of America, and Philadelphia is no exception. Zip code is a major predictor of access, and a Philadelphia Department of Public Health 2015-2019 survey shows the greatest need for primary care doctors is in Northeast and West/Southwest Philadelphia: the 3 zip codes with the highest emergency department (ED) encounter rates were all located in North Philadelphia [1].


This is important to note because without a primary care doctor, the ED is your only option, and it can quickly become very expensive. Poor access to a doctor can lead to unnecessary emergency room visits that could have been addressed more quickly and cheaply by primary care doctors.


Many factors are at play here, including lack of health insurance and cost of healthcare. But one additional problem is a lack of doctors, particularly in rural and low-income neighborhoods across America. This is a problem unlikely to solve itself. Different groups have predicted a major shortage of doctors in the future as our population grows larger and older – the American Medical Association, for example, predicts a shortage of 40,000 up to 100,000 doctors unless we find or train more doctors [2].


What’s the process of becoming a doctor?

Usually, the process starts by graduating from high school, then graduating from college, then applying to medical school. But it doesn’t stop there – after graduating from medical school, the last step is getting into a residency program. That is where doctors learn to treat the type of patients they will be seeing every day, whether that be kids or patients with lung problems. “Residents,” as these new doctors are called, are paid a salary that averages around $60,000 and they work very long hours, often up to 80 hours a week.



Medical residents are paid by the government

Since the mid 1960s, resident salaries have been paid for by Medicare, which itself is funded by taxes. Before that, residents actually weren’t paid at all! And since Medicare is a government program, the United States Congress and Senate pass bills that decide how Medicare dollars are spent. Since 1996, the amount of resident salaries Medicare was allowed to pay for has largely remained frozen and unchanged at around 100,000 residency slots [3]. A bill currently in the senate could be set to change that.


This new bill, the “Resident Physician Shortage Reduction Act of 2021” introduced by senator Bob Menendez of New Jersey, would direct Medicare to pay for an additional 2,000 residency positions per year for 7 years, from 2023 until 2029 [4]. That’s an additional 14,000 doctors by 2030!


Who benefits

Many medical students finish medical school and rack up hundreds of thousands of dollars in debt, and still are not able to match into a residency due to residency shortages. So that’s one group who benefits.

But more importantly, for many living in the United States, it is very difficult to find access to a doctor in a timely manner. Rural and lower-resource populations need doctor access more than others, and certain types of doctors are in higher demand than others. For example, mental health providers and family doctors are in very high demand because many people have mental health disorders and common illnesses like diabetes which can be treated by a family doctor. This is factored into this bill – most of these residencies would go towards training the doctor specialties in highest need.


Additionally, these residents would be placed in regions where healthcare access is lowest such as rural areas and “health professional shortage areas” (referring mainly to urban areas without nearby affordable high-quality health care). [4]


What’s next

For this bill to become law, it still has to pass through the Senate, the House of Representatives, and be signed by the president. This would be a big win for both patients and healthcare providers, at relatively low financial cost for the government, but it will certainly take time. There are still other possibilities that exist, like hospitals or states paying for residents themselves, but this would be an unlikely outcome because like most people, hospitals and states don’t like to spend money when they can avoid it.


For now, keep an eye on the Resident Physician Shortage Reduction Act of 2021 and encourage your elected representatives to support it and support increased healthcare access!


Links to check out

Read the official Resident Physician Shortage Reduction Act here

Contact your House representative here

Contact your Senate representative here




Author: Drew Davis, medical student at Drexel University College of Medicine.

See more on twitter at @DDhealthhistory

Contact: drewjdavis@gmail.com

Disclaimer: The opinions expressed in this article are my own and do not represent the opinions of any organization with which I am affiliated.


References:

  1. Phila.gov. 2022. Access to Primary Care in Philadelphia, December 2019. Available at: https://www.phila.gov/media/20191218101940/CHART-v4e8.pdf

  2. American Medical Association. 2022. The most powerful prescription? A well-trained physician. Available at www.savegme.org

  3. Weiman, Darryl S, M.D. Nov 15, 2016. Who pays for resident salaries? HuffPost, The Blog. Available at https://www.huffpost.com/entry/who-pays-for-resident-sal_b_12967008

  4. Text - S.834 - 117th Congress (2021-2022): Resident Physician Shortage Reduction Act of 2021. (2021, March 18). Available at: http://www.congress.gov/

Image sources:

Image 1: Reference 1

Image 2: Photo by Marcelo Leal on Unsplash

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