Maybe We Don’t Need to Train So Many Doctors

The CEOs of two academic hospitals are upset that Congress may reduce the funding for Graduate Medical Education (GME) paid through Medicare. To fight back, they’ve written a scare story for the Wall Street Journal Op-Ed page (We Can’t Afford to Train Fewer Doctors) that’s full of omissions and misleading statements.

To summarize their arguments:

The CEOs of two academic hospitals are upset that Congress may reduce the funding for Graduate Medical Education (GME) paid through Medicare. To fight back, they’ve written a scare story for the Wall Street Journal Op-Ed page (We Can’t Afford to Train Fewer Doctors) that’s full of omissions and misleading statements.

To summarize their arguments:

• A cut in GME funding “could dramatically limit the ability of patients to see physicians, even for critical illnesses” by limiting the number of new physicians trained
• Hospitals have been buying up physician practices and as a result now provide most primary care, outpatient care, and care for the indigent. Reducing funding in one area (e.g., GME) “will impact all services that hospitals provide to the community”
• We need 90,000 more doctors by 2020 to meet increased demand and to replace doctors who retire

The authors make it sound like a cut in GME funding will doom the country to a dire doctor shortage. I think they’re being over dramatic:

• There is serious overutilization of medical services in this country today. Reduce that and we won’t need so much physician capacity. Conversely, supply creates its own demand. Train more doctors and overall utilization and costs will rise
• I don’t see why a reduction in GME funding will automatically lead to cuts in other programs. If their funding is fungible as the authors imply, maybe hospitals should just find other revenue sources to substitute for lost Medicare GME. Or maybe GME cuts can be offset by reductions in overhead expenses such as administrator salaries?
• Technology and process improvement should make physicians more productive. The number of farmers has dropped dramatically as agricultural methods have improved. To get costs under control we’ll need to see some of the same effect in health care
• Plenty of well-trained physicians from overseas are interested in working in the US. We could make up for some of the expected shortage by encouraging more immigration
• Physicians aren’t the only medical providers out there. Nurse Practitioners and Physician Assistants are an important, growing component of the clinical work force and can continue to take up some of the slack