Three points drive the health care discussion: cost, quality and access. For the average person, quality and cost are subjective measurements, not always easily understood. Access is simpler. “Can I see a doctor when I need to?” Yet when access is discussed, the focus often tends to be access to health insurance. However, with the current shortage of all physicians, especially primary care specialists, access to a doctor is equally important yet often ignored.
For most individuals and families, access to care comes through primary care physicians, and according to the American Association of Colleges of Osteopathic Medicine the primary care physician shortage is projected to exceed 50,000 by 2025. Veterans Affairs is already facing a concerning doctor shortage at its medical facilities. The recent and unfortunate issues with its hospitals in Arizona and around the country provide a distressing example of how physician shortages can dramatically impact patient care.
There are two principal reasons for the projected physician shortage. One is the ability of U.S. medical schools to graduate an adequate number of physicians. Medical schools can increase their class size in an attempt to address the shortages, but a second challenge occurs after graduation when new doctors receive specific training in their desired field of specialization.
Graduate medical education, often referred to as residency training, offers specialized training, typically at teaching hospitals. This training is primarily funded — greater than 90 percent — by federal dollars. Unfortunately, the money available for these vital training programs was capped by the Balanced Budget Act of 1997, at pre-1996 levels. This cap severely limits training. As a result, there will not be an adequate number of physicians trained, in all specialties, to address the needs of the U.S. population.
Over the past 17 years our population has grown, life expectancies increased and the number of patients living with chronic illnesses has risen. To avoid a crisis similar to our VA health care system, we need to provide an adequate number of physicians, especially primary care physicians.
Our medical schools can address the initial education of physicians. However, the artificial cap on the number of funded graduate medical education positions limits final training opportunities for physicians and thus limits access to care.
This compounds the current primary care physician shortage and has the potential to be the single greatest barrier to accessing quality health care.
Like many medical schools around the nation, the Kansas City University of Medicine and Biosciences has worked to alleviate this problem by increasing class size, now the largest class size in the region. More than 70 percent of our graduates practice in a primary care specialty.
But the solution requires a long-term commitment to investing in expanding the number of training opportunities for our future physicians from a broad spectrum of constituents.
Locally, the health care and business communities need to join with the Kansas City community’s three medical schools to advocate for expansion of federal funding for graduate medical education, as well as seek novel ways to fund physician training in both primary care and other specialties.
The well being of our 315 million Americans depends on it.
Marc B. Hahn, D.O., of Kansas City is president and chief executive officer of the Kansas City University of Medicine and Biosciences and is board certified in anesthesiology and pain medicine.