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    Report questions doc shortage; AUA concerned

    Organization pushing bills that would increase residency slots

    Bob GattyWashingtonA July 29 report by the Institute of Medicine (IOM) on reforming the nation’s graduate medical education (GME) program has struck a nerve with the AUA and other medical societies by questioning the seriousness of continuing physician shortages in the United States.

    While the AUA “applauds” IOM for studying the governance, finance, and regulation of GME in the U.S., Christopher M. Gonzalez, MD, MBA, the AUA’s Public Policy Council vice chair, expressed serious concern with the 205-page document’s conclusion that there is no credible evidence to support claims of a looming physician shortage.

    IOM critical of shortage predictions

    In its report, “Graduate Medical Education that Meets the Nation’s Health Needs,” the IOM said that the underlying methodologies and assumptions about the future physician work force in various studies that predict serious shortages “are problematic.”

    “They generally assume historical provider-patient ratios using existing technological supports and thus have limited relevance to future health care delivery systems or to the need for a more coordinated, affordable, and patient-centered health care system,” the report said.

    “Physician work force analyses that consider the potential impact of changes and improvements in health care delivery draw different conclusions,” it added. “These studies suggest that an expanded primary care role for physician assistants and advanced practice registered nurses, redesign of care delivery, and the use of other innovations, such as telehealth and electronic communication, may ultimately lessen the demand for physicians despite the added pressures of the aging population and coverage expansions.”

    Noting that some are pushing for significant increases in Medicare GME funding by increasing the cap on Medicare-funded residency positions to increase the number of physicians, IOM said evidence suggests that producing more physicians is not dependent on more money for GME. Nor would increasing the number of physicians resolve work force shortages in areas of the country where shortages are most acute or in all specialties and care settings, IOM added.

    The AUA and other members of the Surgical Coalition take issue with that assessment and are calling for passage of legislation in Congress that is directly aimed at resolving physician shortages in both specialty and primary care. In addition, the AUA expressed concern about IOM recommendations to establish a single funding stream.


    Next: Negative impact in teaching hospitals


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    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.


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