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Support Graduate Medical Education

Support Graduate Medical Education

By Kenneth L. Davis

As House Speaker John Boehner has said, the Affordable Care Act is the “law of the land.” The Supreme Court has upheld it. The 2012 election reaffirms it.

Whether you love it or hate it, the law is being implemented.

The law is welcoming 27 million Americans into the health care system and urging them to find a doctor — a regular source of care.


Because research is clear: People with a regular source of care have better health outcomes.

Yet at the very moment we are inviting people into the health system, Congress is considering cutting the single source of training that will ensure we have the physicians we need to look after these individuals, by drastically reducing federal funding for graduate medical education.

We cannot afford to have national health policy that goes in two opposite directions.

When Congress established Medicare in 1965, it recognized that qualified, trained physicians are vital to making our health care system work. That’s why Medicare allocates funding for Graduate Medical Education (GME), so that teaching hospitals (which make up just 6 percent of all U.S. hospitals while providing 75 percent of all physician training) and other providers can ensure a steady pipeline of trained physicians.

But the reality is that even without proposed cuts to federal GME funding, our nation’s demand for doctors is outpacing our ability to meet it.

Consider that nearly one-third of physicians will retire in the next decade. It takes, on average, a decade to educate and train new physicians. At a time when we should be stimulating growth, the number of training positions supported by Medicare is capped (and has been for 13 years). On top of this, we face increased demand from aging baby boomers who will be seeking more care and the newly insured entering the system for the first time.

The Association of American Medical Colleges projects the U.S. will face a shortage of more than 90,000 doctors in just seven years.

Providing more people access to routine care is a fundamental tenet of the ACA. Of the 27 million Americans entering the health care system, many already receive episodic care through outpatient clinics or emergency rooms, but they don’t experience the benefits that a long-term relationship with a primary physician provides. The new law banks on the fact that access to routine and preventive care, and real patient-doctor relationships, will lead to better patient outcomes and reduced costs — and research backs this up. But this will only happen if physicians are there to care for them when they arrive.

Patient-Centered Medical Homes and team-based care may alleviate some of the pressure by allowing fewer physicians to see more patients and more patients to be seen by physician assistants and nurse practitioners. At Mount Sinai, we already have such protocols in place at our hospital and have established a new program within our School of Medicine to encourage more medical students to pursue primary care. These measures may help reduce the physician shortage, but they will not eliminate it. And while physician assistants and nurse practitioners can ease the shortage by helping manage certain patients, increasing their numbers will not solve the problem. The fact remains that instead of constricting the pipeline of new physicians, we should be innovating new ways to grow it.

There is no question that difficult budget cuts are needed at the federal level, and reductions in health spending must be on the table.

But there are better ways to cut health costs than slashing the number of physicians. Efforts to reduce obesity-related diseases, which account for nearly 10 percent of all U.S. health care expenditures, are one place to start. A penny-per-ounce tax on sugary beverages would cut obesity and diabetes and raise an estimated $10 billion per year according to an analysis from the Center for Science in the Public Interest. Medicare drug rebates would provide an estimated $112 billion over 10 years according to the Congressional Budget Office.

And a recent analysis in Health Economics finds that negotiating better drug prices under Medicare like we do for Medicaid and the Veterans Administration would save an estimated $14 billion annually — more than enough to fund GME.

The true power of the ACA will be realized when every American has access to the kind of routine, preventive care that comes with an ongoing relationship with a health care provider.

Millions are being spent to educate Americans about the ACA, what their options are and how to find providers. When they knock on our doors, we need to make sure the physicians are there.

Without GME funding, the ACA could become an empty promise.

Kenneth L. Davis, M.D., is president and CEO of The Mount Sinai Medical Center, New York City.

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