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Medical Resident Shortage Hinders Rural Patient Care Access

With fewer medical residents being trained in underserved areas, it puts a blight on rural patient care access, GAO found.

Medical resident shortages in non-urban areas hinder rural patient care access.

Source: Thinkstock

By Sara Heath

- Medical residents beginning their careers are unevenly concentrated in the Northeast and urban regions of the United States, potentially exacerbating clinician shortages and hindering rural patient care access, according to an assessment from the Government Accountability Office (GAO).

From 2005 to 2015, 30 percent of medical residents practice in the Northeast, although the lowest proportion of patients resided in the Northeast.

In 2015, the Northeast had 69 medical residents per 100,000 patients. The South had a similar number of medical residents – approximately 30 percent of all residents nationwide – but due to its larger population, had a ratio of only 31 residents per 100,000 patients.

A similar issue prevailed in urban areas, the report showed. Ninety-nine percent of medical residents practiced in urban areas between 2005 and 2015. However, there was notable growth in residents in rural areas during that time.

Nonetheless, urban areas still saw a higher number of graduate medical residents during the test period, increasing to 126,355 residents by 2015.

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Conversely, the maximum number of residents practicing in rural areas in the 10-year period totaled to 1,223.

GAO acknowledged that the high proportion of residents in the Northeast may be a result of the region’s many healthcare resources. The Northeast – and urban areas in general – have more resources for training graduate medical residents, GAO said.

“GME training must be based in areas that can support requirements for accreditation, including adequate patient volume and teaching quality,” the agency explained. “As a result, it tends to be primarily located in certain areas, such as urban areas.”

The investigators contended that although the number of medical residents did not change between 2005 and 2015, the concentration of residents in the Northeast and in urban areas has adversely affected patient access to healthcare and the clinician shortage issue.

The agency also argued that the federal government – which offers incentives for employing residents in medically underserved areas – has not been doing enough to fill these gaps.

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“GAO found that the primary federal efforts intended to increase GME training in rural areas were incentives within the Medicare program that can provide hospitals with higher payments for such training,” GAO reported. “However, hospitals’ use of these incentives was often limited, and certain Medicare GME payment requirements could present barriers to greater use.”

Of the few rural hospitals that offer graduate medical education training (7 percent of all training hospitals are rural), many utilize the first incentive. This incentive sets resident caps. Once the hospital exceeds that cap, it becomes eligible for Medicare payments. Most rural hospitals come close to or exceed this cap.

However, the second incentive, which essentially requires a rural hospital to offer resident training in more than one specialty (family medicine versus internal medicine, for example), is harder to meet. Thus, there is underutilization of these incentives.

The third incentive asks urban hospitals to enact a rural medical training track. While GAO was unable to access specific CMS data on the matter, subject experts explained to the agency that few hospitals took advantage of this incentive.

GAO recommended the government establish a set of strategies to redistribute medical residents in high-needs areas. Specifically, GAO recommended HHS act on prior suggestions to drive needed medical residents in medically underserved areas.

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“As a result, the efforts may not be sufficient to meet projected primary care workforce needs,” GAO concluded. “Further, GAO recommended in 2015 that the Department of Health and Human Services (HHS) develop a comprehensive and coordinated plan for its health care workforce programs, which is critical to identifying any other efforts necessary to meet these needs, and has not yet been implemented.”

Inadequate provider workforce is the cause of many patient healthcare access issues, industry experts have said. Research has shown when there are too few clinicians to serve patient demand, patient care suffers and wait times increase. This issue is especially prevalent in rural and other medically-underserved areas.

Stakeholders around the country are working on finding a fix for patient access problems and the clinician shortage issue.

Earlier this month, the AHA gave its seal of approval for companion legislation in the House of Representatives and Senate that would create 15,000 Medicare-funded residency positions across the country. These positions would be distributed on a needs-based hierarchy.

“Your legislation outlines a hierarchy for distributing the new slots, prioritizing teaching hospitals that are currently training residents in excess of their cap, those in states with newly opened medical schools, those that emphasize training physicians in community-based or outpatient hospital settings, and those that operate a rural training track,” AHA Executive Vice President Thomas P. Nickels wrote in public comments.

“We believe this approach responsibly addresses the nation’s urgent need for additional physicians.” 

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