By Mary Mayhew
Most physician residency programs (graduate medical education or GME) start this month. Medical and osteopathy school graduates who earned a residency spot start the next stage of their medical education. First-year interns become second-year residents. Second-years become third-years, and so on. It’s a big day for individuals on a journey to become pediatricians, cardiologists, psychiatrists, neurologists, or any of a number of other specialties needed to provide a full array of health care for Floridians of all ages.
Increasing the number of residency opportunities in Florida hospitals is essential for addressing the physician shortage, which is projected to reach 18,000 by 2035. Where a resident completes his or her training is highly predictive of where he or she will eventually practice medicine. Of Florida’s nearly 8,616 residents who completed training between 2012 and 2021, 63 percent stayed in the state after completing their residency to practice medicine, according to the Association of American Medical Colleges. That’s why it is so critical that Florida has robust and multi-specialty residency programs and enough residency positions.
Florida has 281 residency programs and 4,126 residents in training. In comparison, California has 474 residency programs and 9,095 residents in training. Residency training can range from three to eight years, depending on the specialty, and the cost can range anywhere from $35,164 to $226,331 per resident per year.
Lack of funding is one of the biggest barriers to increasing the number of residency programs and residency positions. Medicare is the largest single program providing financial support for GME, but the number of Medicare-funded GME residency slots/positions for each hospital is capped. Medicare provides no funding for residents that exceed each hospital’s cap. Almost 90 percent of hospitals had their funding caps set in 1997, meaning funding has been frozen for over 25 years. Today, Medicare GME payments support just 75 percent of Florida’s medical residents. This stagnant funding formula also has failed to keep pace with the significant increase in Florida’s population, resulting in inequitable Medicare funding distribution to states like New York and Massachusetts that are receiving substantially more GME funding than Florida.
Recognizing the need for solutions and funding, both the U.S. Congress and the Florida Legislature have made much-needed investments in GME. The Florida Legislature recently increased GME funding by 48 percent. The state’s budget for 2023-2024 includes an additional $93.8 million for a total of $191.08 million for the statewide residency program and a recurring $30 million to create the Slots for Doctors program to expand the number of residency slots. The new program supports the creation of 300 residency positions in specialties identified as being in short supply, including cardiology, endocrinology, gastroenterology, family medicine, and vascular surgery.
At the federal level, Congress appropriated new funds in 2021 and 2023 to increase the number of Medicare-funded residency slots. The Consolidated Appropriations Act of 2021 funds 1,000 new Medicare-supported GME slots through FY 2031, and the Omnibus budget package passed Congress in late December 2022 includes 200 additional Medicare-funded GME slots beginning in 2026. These additional funded slots are nationwide and not guaranteed for Florida. But, although this funding supports only a fraction of the number of residencies needed to solve the physician shortage, it is an important acknowledgment of the critical need for more physicians.
Between 2021 and 2022, no state grew more quickly than Florida. Having enough physicians to care for this growing and aging population is a challenge that cannot be ignored. Fortunately, lawmakers in Washington and Tallahassee are taking note and providing funding to support hospitals in their work to educate tomorrow’s doctors today.
Mary Mayhew is President and CEO, Florida Hospital Association.
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