Blog Archive

Tuesday, August 8, 2017

HCA Is at the Forefront of a Solution to the
Residency Shortage

Hospital Corporation of America is leading the charge for a timely solution to the Residency Shortage nationwide.  “Nationally, HCA is one of the largest GME providers, with more than 203 programs….Currently 2,750 residents and fellows are participating and that number is expected to grow to 5,500 by 2020”.(1)  This would mean an additional 70 residency programs.  Perhaps other hospital corporations will follow HCA’s example.  The slow moving bureaucracies of Medicare Funding, the ACGME (Accreditation Council of Graduate Medical Education), and state licensure laws have precluded a timely solution in the public sector. 

Here is what is going on in Florida, where HCA says, “The physician shortage is especially critical in Florida”.  An IHS Global study found that Florida faces a shortage of about 7,000 physician specialists by 2025.  The Teaching Hospital Council and Safety Net Hospital Alliance report said, “We are not, to put it bluntly, training enough physicians….Without more physicians, Florida will have a tough time providing quality health care to our growing, aging and increasingly diverse population.”  You may recall from a prior blog that in 2015 Florida began a “GME Start-up Bonus Program” which funded $100,000 for each new residency “slot” in shortage specialties.  I would assume that HCA is taking advantage of these bonuses to help fund their new residency slots.  In Florida, HCA says,”Currently 336 residents …are training at one of our seven teaching hospitals, with plans to expand to more than 550 residents by the 2018-2019 academic year.”

The other 49 states seem to be approaching these Residency and Doctor Shortages in many different ways.  I see the private sector approach working very nicely in Florida, and would encourage other states to offer similar incentives to the hospital corporations operating in their states.  However, I would still mention that until the Residency Shortage is solved, each state give preference to its own citizen applicants for residency, as well as those unfortunate doctors who have not matched in prior years.  Upon completion of residency, many doctors opt to practice in the state of their training.  Why should a state offer incentives for new residency slots, only to have these trained doctors leave their state when finished? 

(1) HCA West Florida 2017 Community Report


  1. Whether GME funding from medicare or state it should be trainee-centered in the form of voucher for example. The state can then attach the voucher to specific commitment from the trainee, for example to serve in the state for certain period of time. I think that Congress instead of paying the hospitals directly can distribute the GME fund to the trainees or at least give the states the leverage of managing the fund so that each state can demand the participating hospitals in the state to behave according to the state's needs for GME.

  2. I felt that I needed to make another comment.
    In a response to the recent Google engineer’s manifesto, Anita Hill said in an article titled "Class Actions Could Fight Discrimination in Tech" in The New York Times yesterday: "We can’t afford to wait for the tech industry to police itself — and there are few indications that it will ever do so".
    The reason for mentioning that is that although the treatment of women in the Silicon Valley is different problem from the problem of the unmatched doctors they have the same venue for the solutions which is the judicial system.
    As I mentioned in a previous comment the medical establishment, whether public or private sector, cannot police itself. There is something wrong in the GME system, how can they deny a qualified doctor from not only a path to license but also to employment by simple bureaucracy that there is no residency position to him/her?
    How can physician assistant and nurse practitioner practice but unmatched doctor can't?
    I strongly believe that with experienced lawyers not only the unmatched doctors can win justice in class-action lawsuit in the court of law but also the problem of shortage of doctors would be resolved and that would be good for the patient care and for the healthcare system as a whole.