Menendez, Boozman, Schumer Introduce Bipartisan Legislation to Combat Doctor Shortage as Crisis Worsens

Menendez, Boozman, Schumer Introduce Bipartisan Legislation to Combat Doctor Shortage as Crisis Worsens

   

WASHINGTON, D.C. – U.S. Senators Bob Menendez (D-N.J.), John Boozman (R-Ark.) and Chuck Schumer (D-N.Y.) today introduced the bipartisan Physician Shortage Reduction Act of 2019 to increase Medicare-supported doctor training slots by 15,000 to help address the growing nationwide physician shortage crisis.  According to the Association of American Medical Colleges, the U.S. is expected to face a shortage of more than 120,000 primary care and specialty physicians by 2030. 

“With an older physician workforce, and an aging population overall, the demand for qualified doctors in New Jersey is quickly outpacing supply,” said Sen. Menendez.  “We simply have far too few medical school students and physician residents in the training pipeline in order to catch up.  If we’re going to meet the future needs of our residents and ensure access to quality health care, we must close the gap by lifting the arbitrary cap–quickly.”

“It is no secret that our health care system is in need of significant reform. However, there are some reasonable, simple steps we can take to increase access to quality medical services in Arkansas,” said Sen. Boozman.  “Lifting this antiquated cap on training slots for medical school graduates is a perfect example of a small reform that can make a big difference. The number of available physicians per population in the Natural State is among the lowest in the nation and providers of all specialties are facing a serious shortfall, especially in Arkansas’s rural communities. This commonsense bill is a small step toward a system that ensures access to affordable, quality care for every American. Senator Menendez and I encourage our colleagues to join with us in this effort.”

“One of the most pressing issues millions of Americans face right now is the nationwide shortage of physicians -- from primary care physicians that are often the first phone call we make when we are feeling sick, to OB/GYNs that protect and advance women’s health while safely bringing new life into their lives, and specialty physicians that for many embody what it means to be a lifesaver,” said Sen. Schumer. “The Physician Shortage Act of 2019, which I am proud to champion, will tackle this problem head-on by creating 15,000 new residency training slots across the United States and prioritizing those slots for communities that need them most. I’ll fight tooth and nail to see that this critical legislation passes the Senate and is signed into law, to ensure that all Americans have easy access to a physician and the care and medical services they deserve and need.”

In 1997, the Balanced Budget Act created an arbitrary cap on the number of Medicare-funded graduate medical education (GME) positions.  The Resident Physician Shortage Reduction Act would increase the number of GME positions nationwide by 3,000 a year for five years.

“The United States is facing a critical shortage of more than 121,000 primary care and specialty physicians by 2030, putting our country’s health security at risk. The AAMC greatly appreciates Senators Menendez (D-N.J.), Boozman (R-Ark.), and Schumer’s (D-N.Y.) ongoing commitment to address the physician shortage and applauds their introduction of the Resident Physician Shortage Reduction Act of 2019,” said Darrell G. Kirch, M.D., President & CEO, Association of American Medical Colleges.  “Physicians are a critical element of our health care infrastructure and this bipartisan legislation would make a strategic investment in the health care workforce by providing a measured increase in federal support for physician training. We are committed to working with these lead sponsors, and all members of Congress, to alleviate the doctor shortage for the benefit of all Americans.”

“Our goal is a healthy New Jersey, where all individuals in every zip code have access to the healthcare services they need,” said NJHA President and CEO Cathy Bennett.  We applaud Sen. Menendez for introducing the Resident Physician Shortage Reduction Act to help New Jersey’s teaching hospitals grow the next generation of physicians and ensure access to medical care across our state.”

“This much-needed bill underscores not only the critical importance of teaching hospitals and their mission to train medical residents, but also the crucial need to address the nation’s worsening physician shortage,” said Kenneth E. Raske, president of the Greater New York Hospital Association, which represents seven hospitals and networks in New Jersey, including Hackensack Meridian Health, Holy Name Medical Center, New Bridge Medical Center, St. Joseph’s Health, Trinitas Regional Medical Center, University Hospital, and the VA New Jersey Health Care System.  “The entire teaching hospital community thanks Senator Menendez, Senate Minority Leader Schumer, and Senator Boozman for their leadership on this vital issue.”

New Jersey currently suffers from a shortage of physicians. A New Jersey Physician Workforce Task Force reports estimates that an additional 2,500 to 2,800 physicians by 2020 are necessary to meet New Jersey’s health care needs.  According to data from the New Jersey Hospital Association (NJHA), a third of New Jersey’s practicing physicians are over 60 years-old, the third highest in the nation, and the state ranks 46th in the nation in the percentage of doctors under 40, according to the Association of American Medical Colleges. 

Each year, New Jersey has approximately 3,100 physician residents in training at 43 hospitals. At the same time, NJHA estimates that New Jersey has approximately 32 medical students and resident physicians in training per 100,000 residents compared to 81 and 62 in neighboring  New York and Pennsylvania, respectively.

The Senators’ bill would prioritize increasing positions in states with new medical schools, hospitals training physicians in excess of their cap, hospitals who partner with VA medical centers, as well as hospitals who focus on community- based training setting.

Full Bill Summary by Section:

The Resident Physician Shortage Reduction Act of 2019 

This legislation would take critical steps to address the growing physician shortage and strengthen the nation’s health care system.  According to the most recent projections, the United States will face a physician shortage of between 42,600 and 121,300 physicians by 2030[1].

Currently, an artificial cap that on Medicare graduate medical education (GME) instituted more than two decades ago, a cap that remains in place today, hinders the expansion of physician training. The Balanced Budget Act of 1997 (P.L.105-33) limited the number of medical residents that could be counted for purposes of calculating direct graduate medical education (DGME) and indirect medical education (IME) payments to the number of trainees as of 1996. This limitation effectively prohibits existing teaching hospitals from receiving Medicare-support for any new medical residency positions added after 1996. As medical school enrollment continues to grow (up 30% since 2002[2]), the Medicare GME cap has made it difficult for medical resident training to keep pace, resulting in a severe bottleneck in physician training.

 

To address this critical issue, the Resident Physician Shortage Reduction Act of 2019 would increase the number of Medicare-supported direct graduate medical education (DGME) and indirect medical education (IME) medical resident training positions by 15,000 over five years. The legislation also requires the Comptroller General to conduct a study on strategies for increasing health professional workforce diversity.

Section 1. Short Title

Section 2. Distribution of Additional Residency Positions

This section would amend the Social Security Act (42 U.S.C. 1395ww(h)) to allow for increased payments for Direct Graduate Medical Education (DGME) costs. Specifically, the section would authorize 15,000 new Medicare-supported medical residency positions over five years (from 2021-2025, with 3,000 allotted per year).

Allocation of new GME training positions: The legislation sets forth criteria for how new GME training positions will be allotted to qualifying teaching hospitals. These criteria require the Secretary to distribute new GME positions to hospitals based on the following priority order, including to: 1.) hospitals in states with new medical schools or new branch campuses; 2.) hospitals training over their current GME slot cap; 3.) hospitals affiliated with Veterans Affairs medical centers; 4.) hospitals that emphasize training in community-based settings or in hospital outpatient departments; 5.) hospitals that are not located in a rural area and operate an approved “rural track” program; and 6.) all other hospitals.

Requirements for Use of Additional Positions: The bill would require participating hospitals to ensure that at least 50 percent of the new GME positions are used for a shortage specialty residency program, the total number of teaching positions in a given hospital is not reduced prior to the increase, and the ratio of residents in a shortage specialty program is not decreased prior to the increase.

Number of residency positions per hospital: This bill allows qualifying hospitals to receive up to 75 new GME training positions per year over the five-year period.

GME funding: This bill would require new GME training positions be funded in line with current Medicare reimbursement levels, specifically at the otherwise applicable per resident amounts for DGME purposes and using the usual adjustment factor for IME reimbursement purposes.

Section 3. Study and Report on Strategies for Increasing Diversity

The legislation also requires the GAO to conduct a study on strategies for increasing health professional workforce diversity. The study shall include an analysis of strategies for increasing the number of health professionals from rural, lower income and underrepresented minority communities.

Such study is due within two years of date of enactment and shall include recommendations for legislative and administrative actions.