Doctor Shortage Looms Amid Hospital Funding Gap

From Bloomberg News. The shortages aren't going ot be limited to drugs--Obamacare is causing a shortage in DOCTORS, and it isn't even enacted yet!

"With a shortage of doctors looming that may damage patient care in the U.S., teaching hospitals say President Barack Obama’s deficit-reduction plan could make things worse.

After doctors graduate from medical school they must train at teaching hospitals, which get some of their funding through Medicare, the health program for the elderly and disabled. Obama’s proposal to cut $248 billion from Medicare over 10 years includes $1 billion in trims to teaching hospitals, which could lead to fewer residency slots for doctor training programs.

“We are doing things to find costs we can take out so we don’t cut people, but there’s only so far you can go with that,” said Herbert Pardes, New York-Presbyterian Hospital’s chief executive officer. “What else are you going to cut when most of your budget is people?”

The teaching hospital of Columbia and Cornell universities, New York-Presbyterian receives Medicare funding for about 1,600 residents and pays for an additional 200 with money raised through philanthropy, Pardes said. Further cuts to Medicare could mean the hospital eliminates some of those slots, he said.

Obama is expanding health coverage to 30 million more people, swelling the demand for medical services. By 2020, there will be a shortage of 90,000 doctors, the Association of American Medical Colleges estimated.

Pardes isn’t alone in predicting a crisis. Forty physician and hospital groups this week sent a letter to the Joint Select Committee on Deficit Reduction, saying the cuts will worsen an “already problematic” national physician shortage.
Reduced Training Programs

“My guess is you’ll have a significant number of institutions reduce the size of their training programs,” said Atul Grover, chief advocacy officer of the Washington-based association, known as AAMC. The group represents all 135 accredited medical schools in the U.S., as well as teaching hospitals and health systems.

Teaching hospitals get about $3 billion a year through Medicare for doctor training and related expenses, or about 23 percent of the total cost, according to the AAMC. They also get $6.5 billion from Medicare for indirect medical-education costs such as maintaining burn units and organ transplant centers.

The American Medical Association and the National Association of Children’s Hospitals were among the groups that appealed to the deficit-reduction committee. In their letter, they said they were “gravely concerned” about cuts in Medicare support for graduate medical education.
Primary Care Physicians

“We are sensitive to the need for more primary-care physicians,” said Meg Reilly, a spokeswoman for the White House Office of Management and Budget. She said Obama’s plan doesn’t affect payments that directly fund resident slots. Instead it “modifies indirect medical education payments” used for patient-care costs at teaching hospitals, she said.

With lower reimbursements and tighter budgets, it will be more cost efficient for hospitals to hire nurse practitioners and physicians’ assistants, who can fulfill some, not all, of a resident’s duties, said Richard Cooper, emeritus professor of medicine at the Hospital of the University of Pennsylvania in Philadelphia.

“The response of hospitals to the decreased availability of funds is to cut residency positions,” Cooper said. “I don’t really think that hospitals will be highly motivated to add funding.”

The number of medical school graduates has been increasing. There were about 15,500 in 2002, growing to about 17,000 this year, and that number will climb to about 21,000 in 2015, according to Grover. The gains come from schools adding seats to existing programs and as new medical colleges open. Seventeen additional programs are in development, including nine medical schools that have enrolled students. Among them are Hofstra University in Hempstead, New York; University of Central Florida in Orlando; and Oakland University in Rochester, Michigan.
‘Disastrous Consequences’

“The entire health-care system is predicated on having well-trained physicians,” said Adam Wulkan, who completed his third year at the University of Miami Miller School of Medicine and is taking a year off to do research. Reimbursement cuts to teaching hospitals “would have pretty disastrous consequences,” he said. “You don’t leave four years of medical school and have any capability of taking care of patients completely on your own.”

Hospitals spend about $13 billion annually to train residents, Grover said. That breaks down to about $145,000 per resident, including the average first-year salary of $46,000, he said.
‘Tremendous Costs’

“Teaching hospitals carry tremendous additional costs to provide training,” said Sam Hawgood, medical school dean at the University of California, San Francisco. “It’s not simply hiring a resident and putting them to work. A huge amount of infrastructure is required.”

For the past six or so years, there’s been enough of a margin on clinical revenue to pay for some extra residencies, said Grover. Low reimbursements for patients on Medicaid, the government’s health program for the poor, and a tighter private insurance market, are shrinking those margins.

U.S. Senators Bill Nelson of Florida, Charles Schumer of New York and Majority Leader Harry Reid, all Democrats, reintroduced a bill Sept. 23 to increase the number of Medicare- supported residency slots for doctors in training by about 15 percent, or 15,000 slots, over five years.

“There needs to be more residency slots,” said Susie Ahn, health counsel to Nelson.

Graduate medical education is “such an obvious target” amid the talk about cutting Medicare, said Richard Abrams, director of the internal medicine program at Rush University Medical Center in Chicago, which has about 675 residents and fellows, or doctors in post-graduate training programs, even though it is capped by Medicare at about 500.

“Politically, it would be a whole lot more popular than it would be to cut services to patients.”

...and this is supposed to expand access to care HOW exactly? Yes, more people get covered in one way or another, but covered for WHAT when there aren't any doctors to see them, or drugs to treat them with! People will be led into treating themselves the Finish and Russian way--drinking themselves to death, or the celebrity way: drug overdose. Is it any wonder Europeans are so unhappy?