Medicare Graduate Medical Education Payments

VII. Key Issues: Regulation & Reform >> B. Health Care Regulation >> Health Professionals Regulation >> Graduate Medical Education (last updated 11.13.16)


Federal graduate medical education (GME) payments help ensure a level playing field across U.S. teaching hospitals since it provides a far more stable and equitable source of funding than if each hospital had to attempt to cover its own teaching costs based on private patient revenue surpluses that might vary widely across facilities. The rationale for the recently imposed cap on residency positions was the perception that the U.S. had an adequate physician supply and would not be well served by creating a large surplus of physicians. The Duke Center for Health Policy has developed a draft working paper assessing the costs and benefits of Medicare GME payments for health professionals (P4-Medicare GME Payments).

  • The American Association of Medical Colleges estimates that by 2015, the shortage of doctors across all specialties will quadruple, to more than 60,000. By 2025, that number will reach 130,000. Last year there were 45,266 medical school applicants competing for 19,517 seats. A bill recently introduced in Congress would increase the number of residency training programs by 15,000 over five years.
  • HRSA. Projecting the Supply and Demand for Primary Care Practitioners Through 2020 (November 2013).
    • Without changes to how primary care is delivered, the growth in primary care physician supply will not be adequate to meet demand in 2020, with a projected shortage of 20,400 physicians. While this deficit is not as large as has been found in prior studies, the projected shortage of primary care physicians is still significant.
    • Under a scenario in which the rapidly growing NP and PA supply can effectively be integrated, the shortage of 20,400 physicians in 2020 could be reduced to 6,400 PCPs.
    • Also see ACA and Physician Shortage.

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