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How Congress causes (and could fix) the doctor shortage

We have a pretty serious doctor shortage looming right now: Right now, we have about 15,000 fewer doctors than we need to treat the population's medical needs. The Association of American Medical Colleges expects that number to grow to 63,000 as soon as 2015, as the Affordable Care Act expands access to health insurance.

We talk a lot about the fact we have a doctor shortage; I've written about it for the Post and The New York Times ran a front-page story on the subject last month. What gets less attention is a fact that Bloomberg's Alex Wayne points out: The solution to the doc-fix is staring us in the face.

The residency program to train doctors has, for decades, largely been financed by Medicare. Back in 1997, when Medicare costs were skyrocketing, Congress passed the Balanced Budget Amendment. Among its many provisions to control Medicare cost growth, it included a hard cap on how many residencies it would fund.

That residency cap remains in place right now. It is a lot of the explanation for why we have too few doctors.

Medical schools are holding back on further expansion because the number of applicants for residencies already exceeds the available positions, according to the National Resident Matching Program, a 60-year-old Washington-based nonprofit that oversees the program.
“The training programs know that they are not now able to train the numbers of physicians that are going be needed,” said Tom Price, a Republican congressman from Georgia. “We need to be proactive on this as opposed to reactive. We’re actually already later than we should be in addressing the issue.”

Rep. Allyson Schwartz (D-Penn.) and Rep. Aaron Schock (R-Ill.) are co-sponsoring legislation that would eliminate this cap.  “It is an expense that is necessary,” Schwartz told Wayne in an interview. “We’ve seen an increase in the number of doctors that medical schools are training in this country. There’s not an adequate number of residencies” to handle that increase."

Money, as it is for many things in Washington, will likely be the holdup. It costs about $145,000, on average, to train a doctor. Fixing the 63,000 doctor shortage expected in 2015, then, would come with a $9.1 billion price tag. That's not a huge amount when you think of Medicare's overall budget -- $524.6 billion -- but, in Washington, it's not easy money to come by. That probably explains why the legislation from Schwartz and Shock does not yet have a single additional co-sponsor.