Presuming Congress passes some version of a health-care bill and it is signed into law, some 30 million currently uninsured people will suddenly find themselves with access to doctors. But there may not be enough doctors to see them.
In 1997, lawmakers placed a cap on the number of medical residencies—hospital training required for all doctors—in order to contain costs under Medicare, which pays for most of these training slots. Today the U.S. is in the grip of a nationwide doctor shortage, brought on by an aging population demanding access to specialists. Medical schools have stepped up to the plate, announcing plans to add 3,000 new positions for first-time students by 2018. But because the residency cap is still in place, these efforts may not be sufficient.
The health-care overhaul is certain to compound the problem by flooding doctors' offices with newly empowered medical consumers. "Do the math," says Steven M. Safyer, president and CEO of Montefiore Medical Center in New York. "You give millions more people insurance, and it adds up to a much worse shortage."
The doctor crunch is already dire. Last year there were nearly 17,000 fewer primary-care doctors than needed in inner-city and rural areas, according to the U.S. Health & Human Services Dept. By 2025 there will be a shortage of as many as 159,300 doctors, predicts the Association of American Medical Colleges.
Medical schools are trying to help, adding 1,500 seats since 2005. Tufts University boosted its first-year enrollment by 12% in 2009. Dartmouth College increased seats by 7.7%, and the University of Tennessee was up 10%. Still, "It takes years to produce doctors," says Steven H. Lipstein, president and CEO of 13-hospital BJC HealthCare in St. Louis, which trains residents from Washington University.
Federal officials hope to ease the shortage by raising the number of residencies available to students, says Robert Feinstein, senior associate dean for education at the University of Colorado Denver School of Medicine. The cap that stands in their way affects 90,000 of 110,000 residencies at U.S. hospitals, according to the medical college association.
Medicare pays about $100,000 a year per residency, at a total cost to the program of about $9 billion, according to a report filed in June by the Medicare Payment Advisory Commission. The funding was set up in 1965 when the U.S. was about to extend government health coverage to 19 million elderly Americans. As the Medicare rolls grew, to 45 million as of the end of 2008, a ceiling was placed on the number of residencies to control spending.
Congress is now trying to reverse course. On Dec. 5, Senate Majority Leader Harry Reid (D-Nev.), along with Charles Schumer (D-N.Y.), Bill Nelson (D-Fla.), and other sponsors, submitted an amendment to the health-care reform bill that would add 15,000 residencies at a cost to Medicare of about $1.5 billion, according to Atul Grover, a lobbyist with the medical college association. But because Congress is still looking to keep costs down, that figure may drop, if the change is approved at all, during the debate.