March 25, 2014
Dear School of Medicine Community:
Friday, March 21 was a whirlwind of equal parts excitement and anxiety. That was the day our graduating M.D. seniors gathered – along with friends, family and faculty mentors – for Match Day to learn where they will complete their residency years. This annual rite of passage marks an important milestone in the educational journey of our students and it brings back a flood of memories for most physicians, as it did for me.
Increasingly, amidst the joyful chaos, Match Day also brings to mind a topic that I know concerns all of us in academic medicine: the pressing need for more graduate medical education positions.
With health care reform, the need for new physicians – especially in rural and underserved areas, and in primary care disciplines – is growing but the increase in graduate training programs is not keeping up with this demand. Our training programs for new physicians are frozen in the past, literally, due largely to government policy and resulting funding constraints.
Historically, the federal government has funded the lion's share of the costs of graduate medical education programs but in 1997, as part of the Balanced Budget Act, the government froze the number of funded residency positions across the country. This is often referred to as the federal "cap" on resident trainees.
Despite tremendous population growth in Oregon during the past two decades, OHSU and other participating teaching hospitals are locked into a number of training spots that reflect a 17-year-old snapshot of the state's demographic reality. Currently, Oregon is frozen at the ninth lowest resident cap per 100,000 population, at 12.86 (compared, for example, with 77.13 residents per capita for New York, the highest).
Why is this important? Data show that where a new physician completes his or her graduate medical training is often where they end up practicing.
This brings me to what is another essential aspect of our future physician workforce: the distribution of the state's graduate medical education training spots. Right now, the bulk of Oregon's training spots are in urban areas where physician shortages are less acute. Encouraging new physicians to practice in underserved areas of the state requires not only new training positions but also an approach that distributes them geographically. This could take multiple forms, including new partnerships between OHSU, regional health systems and rural communities – to establish training programs in areas where hospitals are not always large enough to provide the comprehensive experiences required for independent accreditation.
At OHSU, we are gradually increasing our medical school class size from about 120 to 160 during the next several years to help meet the state's health care access needs. But without new training spots in Oregon, too many of our new graduates will have to leave the state to complete their training. While many will return – I'm pleased to say that about half of each OHSU graduating M.D. class eventually ends up practicing in Oregon – a more rational statewide approach to graduate medical education distribution is a key element to help stabilize our physician workforce in Oregon for the long-term while also ensuring its alignment with the future health care landscape.
Of course, during the Match Day celebration itself, the exuberance and emotion of the day swept aside these big-picture issues. And rightfully so. I want to congratulate our soon-to-be graduating Class of 2014 on your enormous accomplishments. I have no doubt you will make an important impact on the future of health care and in the lives of your patients. Selfishly, I hope it is in Oregon. And I hope all of us can speak as one in seeking solutions for the outdated funding models that affect our residency programs.
Mark Richardson, M.D., MBA
Dean, OHSU School of Medicine
President, Faculty Practice Plan