SUBJECT: Endorsement of S. 348, the Resident Physician Shortage Reduction Act
Dear Senators Menendez, Boozman and Schumer,
On behalf of the American Association of Neurological Surgeons and the Congress of Neurological
Surgeons, we are writing to endorse your legislation, S. 348, the Resident Physician Shortage Reduction
Act.
As you know, the federal government is the largest single funding source for graduate medical education
(GME), and these contributions are essential to train the best and brightest physicians in the world. And
while each year public funding to support GME tops $16 billion the nation is facing an acute shortage of
physicians due to an aging population and the expansion of health insurance coverage through the
Affordable Care Act (ACA). According to research conducted by the Association of American Medical
Colleges (AAMC), we are facing a severe shortage of between 42,600 and 121,300 physicians by 2030
— with a shortfall of up to 49,300 in primary care and 72,700 in specialty care (including surgeons). The
supply of surgeons, in particular, is projected to have little growth by 2030, but projected demand is
expected to increase, resulting in a shortage of between 20,700 and 30,500 surgeons by 2030. And
while medical schools in the U.S. have increased their enrollments, and additional medical and
osteopathic schools have been established, the number of Medicare-funded resident positions has been
capped by law at 1996 levels.
An appropriate supply of well-educated and trained physicians — both in specialty and primary care — is
essential to ensure access to quality health care services for all Americans. Unfortunately, current GME
payments do not cover the real expenses that academic medical center departments incur to train
residents, straining our ability support more residents to fill the physician workforce gaps. It costs
approximately $1.2 million to train a neurosurgical resident. Contributions from government and other
payers fall well short of covering this expense. Academic medical centers have generally been able to
support the expansion of residency programs out of departmental operational funds since the institution
of the GME financing caps in 1997. However, this is increasingly no longer possible, as payments to
hospitals dwindle and fewer dollars are available for such cross-subsidization.
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