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GME Funding Is Crucial to Addressing the Physician Shortage: Merrill Stewart, MD
Merrill Stewart, MD, Ochsner Health, says insufficient funding from CMS for graduate medical education (GME) limits the ability to expand cardiology fellowships and contributes to the nationwide physician shortage.
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Despite the rising number of medical school graduates in the US, training opportunities have not kept pace, largely due to a shortfall in federal funding for graduate medical education (GME), says Merrill H. Stewart, MD, director of nuclear cardiology and noninvasive and critical care cardiologist at Ochsner Health.
In an interview with The American Journal of Managed Care®(AJMC®), Stewart emphasized the crucial role public investment plays in shaping the next generation of cardiologists. While the Accreditation Council for Graduate Medical Education (ACGME) may approve a certain number of residency or fellowship positions at an institution, Stewart said CMS ultimately determines how many of those positions will be funded. This leaves Ochsner with only 6 funded spots in its program despite ACGME approving 10 of them.
He added that, contrary to the belief that residents and fellows provide inexpensive labor for hospitals, trainees are not necessarily revenue generators until after their training is complete. “They're not necessarily huge money makers for an academic institution,” Stewart said. “It's not like we are making tons of money off of all of our trainees. Without CMS funding for graduate medical education…it would certainly not exist in its current form.”
These funding constraints have a ripple effect across the health care system, especially as the country faces an ongoing physician shortage. According to Stewart, there are more medical school graduates than ever, especially with the rise of osteopathic medicine programs, but residency and fellowship slots haven’t increased accordingly because the funding hasn’t.
“Our current shortage of physicians in the US is driven primarily by a lack of increasing funding of graduate medical education, and if you really want to increase the physician supply in the US, you've got to increase funding for the entirety of the training process,” he told AJMC. It shouldn’t stop at funding medical school either, Stewart argued, it should extend to residency and fellowships. “[GME is] just as much a part of your training as a physician as medical school is itself,” he added. “We kind of treat them separately as a society and as a culture and as a country, and I don't know if that's the best.”
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