Put Up or Shut Up / Residency Shortage
https://www.youtube.com/edit?o=U&video_id=oEpkEa6GEpk
A proposal to create a new medical license was made at the
annual Florida Medical Association (FMA) meeting in August 2017. In order to make a proposal at the FMA a
strict procedure must be followed. A
delegate from a county medical association must obtain approval from their
local medical society to bring a proposal to the state medical
association. Following strict written
guidelines, the delegate is allowed 3.5 minutes to verbally present this
proposal to the delegates. The proposal
presented at this year’s meeting had to do with the creation of a license
called “Assistant Physician”, similar to the license passed in Missouri . This license would allow graduate unmatched US
doctors, who met all the requirements for application to the National Residency
Matching Program (NRMP) for residency, to work under the supervision of a
licensed physician. This would permit
meaningful work in Healthcare until the unmatched doctor could obtain a medical
residency, in lieu of the current residency deficit.
This committee voted that the proposal “not be
adopted”. One of the objections
discussed in a prior blog had to do with the belief that a residency shortage
did not really exist. I have since
received written correspondence from the CEO of the NRMP stating that there
have been 42,000 applications for 32,000 positions. 99% of the positions were filled, leaving 203
unfilled slots mostly in 1-year preliminary surgery, where “Many are dead-end
positions that do not lead to further training”. So there definitely is a residency shortage
of about 10,000 slots per year.
The second objection raised against this proposal was from
the medical student delegates. They
voted “no” because they felt money should be spent on Graduate Medical
Education (GME) for creating more residency slots in Florida, and not money
spent on creating a new license. They
felt the Assistant Physician license “would have legislative implications as
the FMA’s job is to maintain that the physician stays as the leader of the
health care team. This could be a risk
to the public if lesser trained providers are allowed to practice Medicine with
MD/DO after their name.”(1)
The objection based upon how best to spend money to fix the
residency shortage does not correlate with me.
Residency slots are subsidized by Medicare and Medicaid funding
primarily. States like Florida
have created incentive money to hospitals for the creation of new residency
slots. The costs for enacting the AP
license in Missouri were fairly
minimal and involved primarily administrative costs, as delineated in their
proposals. Had these unmatched doctors
been allowed to complete residencies, their applications would have been for
traditional medical licenses, instead of the AP license. So that expense would have occurred
anyway. The administrative costs
associated with supervisory physicians would be additional, but fairly nominal
in view of the benefits to the unmatched doctors and the underserved patients
receiving care. In summary, the worry
about how to best spend money deals essentially with two different levels of
government, the Federal level for Medicare/Medicaid, and the State level for
licensure costs. The two do not impact
one another. So money to create licenses
would not reduce or impact the creation of new residency slots.
How will any of those medical student delegates feel if they
happen to be some of the unfortunate doctors who do not match into a residency
after graduation? They might not be so
cavalier with their objections. What
have these students and the FMA actually DONE to remediate this crisis of the
residency shortage? A doctor in my
community said that the FMA was a “Go along to get along” organization. He implied that nothing much gets done of
significance. For that matter, the AMA
has not effectively dealt with this issue either, from my stand point. So my answer is “Put up or shut up”. If this situation had occurred to any of the
FMA or AMA delegates, we would be hearing a different story!
(1) FMA House of
Delegates 2017; Consent Calendar Reference Committee III ;
Legislation; Aaron Sudbury, MD, Chair.
www.NoMatchMDs.blogspot.com