Medicare graduate medical education is key to improving access to care

Where you live shouldn’t dictate the care you receive, but unfortunately, that’s the reality of our healthcare system. A large part of our health is determined by our ZIP codes—not our genetic codes. A major cause of this trend is a critical shortage of primary-care physicians—the doctors patients rely on as the first point of comprehensive care.

As it stands, the country will need up to 48,000 more primary-care doctors in the next decade. Meeting this urgent need means clearing major regulatory and legislative roadblocks to expand our physician workforce. The good news is, we already have a resource to accomplish this: the Medicare Graduate Medical Education program—but we need to use it more effectively.

Medicare GME—the primary system by which the federal government pays to train America’s physicians—is key to addressing these workforce shortages. While the current Medicare GME system trains thousands of physicians each year, it’s falling short in producing the number of primary-care physicians needed to adequately serve patients—especially those in communities that are historically and contemporarily medically underserved.

As a family physician who has educated numerous medical students and residents, I’ve seen firsthand how an unequal distribution of physicians and lack of access to care in rural and urban underserved areas negatively impacts health outcomes and worsens health disparities. I remember one patient who ended up needing major surgery because she had to wait weeks to get into the clinic in her community. Another patient drove over two hours to visit my practice because there was no primary-care doctor in her town.

About 20% the U.S. population lives in rural communities, but only 11% of physicians practice in these areas. The call to action could not be clearer: we need more primary-care physicians who live and work in underserved communities. Ones who can help patients before they need surgery. Ones that can make sure patients don’t have to drive long distances to receive care. Ones that can care for an aging and increasingly diverse population. And ones that patients and their families trust to provide affordable, high-quality healthcare across their lifespan. But primary-care physicians can’t shift the paradigm alone. This is a systemic problem that requires federal policymakers to step up, too.

The solution to address the primary care workforce shortage and physician maldistribution starts with Congress and CMS; they must adopt a more targeted and purposeful approach for the future of Medicare GME, so more physicians are trained and ultimately choose to practice in areas that need care the most. The first step is to invest in residency programs with a demonstrated commitment to addressing physician shortages.

The next step is to modernize Medicare GME. The federal government spends nearly $16 billion on GME annually. However, the Medicare GME program, which was established over 25 years ago, does not award funding for training based on need. Now more than ever, Medicare GME funding should be updated to advance health equity and address the health disparities I would see in my clinic far too often. To accomplish this, Congress will need to create more residency slots and ensure they are awarded to the areas and specialties with the greatest need.

If leaders in Washington want to make meaningful, sustained progress to advance health equity and eliminate disparities, they can start by more effectively leveraging the programs we already have, including Medicare GME. It’s time to focus on primary care, our future physician workforce, and the communities they will serve—not just for patients and their families, but for the health of our entire nation.


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