How Underfunded Graduate Medical Education Programs May Affect Otolaryngology

Dr. Zubialde said that at the University of Oklahoma School of Medicine, approximately 75% of the cost of resident salaries and benefits is paid for by Medicare and Medicaid funds distributed through hospital partners, while 20% comes from a combination of other hospital and departmental funding, and 5% comes from state money.

“Most of us [otolaryngology residency programs] have the capacity to train more residents, but we’re limited by funding,” Dr. Tsue said. “We have plenty of cases residents can gain educationally from, but we don’t have enough funding to get even five more residents, because that’s half a million dollars.”

Legislative Efforts Stalled

Three bills introduced in Congress last year would increase the number of Medicare-funded residency positions by 3,000 per year over the next five fiscal years. None of them have moved beyond the committees to which they were referred. The AAO-HNS has officially thrown its supports behind two of these bills, both titled the Resident Physician Shortage Reduction Act, which were introduced as companion bills in the House and Senate last March.

According to a statement on the AAO-HNS legislative affairs website, “reductions in GME funding will only cripple the nation’s already dwindling physician pipeline and leave Americans with an inadequate supply of physicians, including specialists.”

President Obama’s 2015 fiscal year budget proposes an additional $5.23 billion over 10 years to train primary care residents in underserved areas. It also calls for a $15 billion reduction in payments to teaching hospitals for doctor training and complex patient care. If passed, this cut would restrict the ability of teaching hospitals to train the next generation of physicians, said Lloyd Minor, MD, dean of the Stanford University School of Medicine.

“This insufficiency will have a significant impact on the future of American medicine, making it more difficult for patients to get access to care while extending waiting times for those that do,” he said.

Dr. Zubialde said otolaryngologists can get involved by working with state health departments that are studying workforce planning issues. “This can be a less politicized way to go about it, if done well,” he said. “But if we do engage here, we need to be ready to come with new and fresh ideas and think outside the box and current agendas.” Results will need to be presented to Congressional leaders, he added.

“There is often little sympathy from legislators to put more money toward programs that assist ‘rich doctors,’ Dr. Zubialde said. “The problem with this bias, however, is it ignores the very real issues and needs at hand. Ultimately, it comes down to how best to educate our patients and politicians about the issues.”