DO Day participants press for GME increases, reallocation

Representing 45 states, white-coated delegations large and small crossed the National Mall and wended through the long corridors of the U.S. House of Representatives and Senate office buildings on March 8. With nearly 1,000 osteopathic medical students taking part, this year’s DO Day on Capitol Hill fittingly focused on graduate medical education’s role in ensuring the future physician workforce, as well as access to quality care.

The Washington, D.C., event’s approximately 1,100 participants pressed for increasing the number of Medicare-funded GME slots, reallocating positions to primary care, and expanding training in rural areas and nonhospital settings—at a time when President Barack Obama has proposed reducing Medicare funding for GME by $9.7 billion over nine years and the bipartisan National Commission on Fiscal Responsibility and Reform (Simpson-Bowles commission) has recommended slashing GME funding by $60 billion over 10 years.

Imposed by the Balanced Budget Act of 1997, caps on the number of Medicare-funded residency positions, as well as restrictions on training residents in nonhospital and community settings, will contribute to a projected shortfall of more than 90,000 physicians, including 45,000 in primary care, by 2020. Cutting GME funding would exacerbate this problem dramatically, the AOA says.

During the DO Day breakfast briefing, AOA leaders and staff urged attendees to advocate for two GME-related bills that would alleviate current and anticipated physician shortages and place physicians-in-training where practicing physicians are needed most:

• The Resident Physician Shortage Reduction Act of 2011 (S. 1627) would increase the nation’s physician training capacity by 15%, adding 15,000 residency slots over the next three years. Designed to accommodate surging numbers of medical school graduates, this Democratic-sponsored bill promotes the training of primary care physicians in nonhospital, physician-shortage venues.
• The Primary Care Workforce Access Improvement Act of 2011 (H.R. 3667) would establish a five-year pilot project to test innovative, locally based residency-distribution models that shift some Medicare-funded positions from hospitals to community health centers and similar settings. This piece of legislation, which has bipartisan support and is expected to be budget-neutral, has a better chance of becoming law than the other, stronger but much more costly, GME bill.

AOA President Martin S. Levine, DO, MPH, encouraged DO Day participants to share their personal stories with their senators, representatives and congressional staffers rather than simply reciting the details of AOA-supported legislation. “Here in Washington, they want to know why you think the way you do,” Dr. Levine said. “When you’re in [lawmakers’] offices, tell them who you are, where you are from, what you want to do with your life, and how they can make it easier for you to practice medicine and take care of the patients who are their constituents.”

Reinforcing the message

“The government acknowledges that we need more primary care physicians, but we are not simultaneously increasing our graduate medical education funding,” Kaleb Veit, OMS IV, told U.S. Rep. John Sullivan, R-Okla., who warmly welcomed 25 Oklahoma delegates into his office.

“Several of us are fourth-years, and we are experiencing firsthand the difficulty of getting a residency slot in Oklahoma,” said Veit, a student at the Oklahoma State University College of Osteopathic Medicine in Tulsa. “We need more graduate medical education slots. If we have more residencies in Oklahoma, more physicians will likely remain in the state to practice.”

Sullivan responded, “I’m for more money going into it, more matching funds that take into account state dollars as well.”

The osteopathic medical profession’s only representative from South Dakota, Seth W. Schmoll, OMS II, discussed the need for more residency programs in his state with Jane B. Lucas, a legislative assistant to U.S. Sen. John Thune, R-S.D. “If I serve a residency in Idaho, Oregon or wherever it may be, it’s going to be harder for me to set up practice in South Dakota,” said Schmoll, a student at the Des Moines (Iowa) University College of Osteopathic Medicine.

Noting that he is more interested in practicing in a rural than an inner-city area, Schmoll pitched the Primary Care Workforce Access Improvement Act. “This would take the GME funding that is already available and look for ways to reapportion it,” he explained. “It would allow residencies to be opened up in community health centers, for example.”

A handful of osteopathic medical students from Nevada met with Carrie L. Fiarman, senior legislative assistant to U.S. Rep. Shelley Berkley, JD, D-Nev., whose stepdaughter is a DO. “We’d like to stay in Nevada, but there are no positions,” said Ori DeVera, OMS I, who attends the Touro University Nevada College of Osteopathic Medicine in Henderson. “We need to increase the number of slots for family medicine.”

After leaving the Nevada congresswoman’s office, the students joined the rest of the Nevada delegation headed toward the office of U.S. Rep. Joe Heck, DO, D-Nev., the only osteopathic physician in Congress.

“One of the reasons I chose Touro Nevada is because an ophthalmology osteopathic residency program opened up,” Quinn Omoto, OMS I, told Dr. Heck when the group gathered in his office. “This past September, the hospital closed it and opened up an orthopedic surgery residency.”

“A new Veterans Affairs hospital is opening in North Las Vegas in August,” Dr. Heck told Quinn. “And one of the things we’re working on is trying to set up ophthalmology residency slots.”

Dr. Heck noted that he and the other physicians in Congress have been working to convince the rest of the House and the Senate of GME’s importance. “We are starting to make some headway and are continuing to fight,” he said.

“People here in Washington are more interested in saving a dollar today than $10 tomorrow,” Dr. Heck remarked.

Members of Congress want to reduce the national debt and deficit while preserving the Medicare program for retiring baby boomers, Dr. Heck explained. “But if we don’t have the physicians to take care of elderly baby boomers,” he said, “we won’t have a program.”