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Why a healthy America needs resident physicians

Residents provide needed care.
Residents are medical school graduates and, having now earned the title physician, are completing their specialty-specific clinical training. This phase, called Graduate Medical Education (GME), is the hands-on education mandatory for physicians to obtain a license for independent practice. This clinical training is arduous and lasts between 3-5 years for medical residents (e.g., internal medicine and pediatrics) and 4-7 for surgical residents (e.g., general surgery and neurological surgery). Residents provide direct patient care, often with a service over education mentality, wherein patient care comes before
I make $11.17/hour before taxes. At my institution, a medical assistant with no degree starts at $13.77/hour. The only wage that I could find similar to a PGY-1 in a hospital setting was a janitor. They average $11.88 per hour. We are earning less than a janitors hourly wage and we have an MD. PGY-1 Family Medicine resident

residents received some or all of their training at VA hospitals while caring for active soldiers and veterans.6

Residents provide complex and acute care.

Without teaching hospitals, many communities would be without vital services, including preventive care. Therefore, affiliation with and funding from residency programs contributes to a healthier community at-large. Teaching institutions often operate at a loss to provide these specialized services and support clinical research, and rely on federal funding to stay afloat. Proposed GME
Teaching hospitals provide: 78% of all burn care units 63% of pediatric ICUs 82% of Level-I trauma center care 68% of surgical transplant services 52% of Alzheimer centers 21% of cardiac surgeryoften for the most severely ill heart patients

formal educational activities. Residents work full time (between 40 and 80 hours weekly) at a median first-year salary of $49,651, which equates to under $13 per hour.1 Meanwhile, they are grappling with crippling student loan debt $166,750 on average.2 Therefore, proposals that limit the number of residency slots would be extremely costly for the system.

cuts could cause hospitals to cut services that operate at a loss including those unavailable elsewhere in the community.

Residents serve the underserved.

Many residents train at teaching hospitals where they care for the underserved, indigent and elderly, including 28% of all Medicaid hospitalizations. Teaching hospitals comprise only 6% of all hospitals, but provide approximately 40% of all charity care at a cost of $8.4 billion annually.3 Teaching hospitals are more likely to do community outreach. For example, 90% of teaching hospitals offer ambulatory services to HIV/AIDS patients, compared to 14 % of nonteaching hospitals.4 Teaching hospitals also support poison control centers, nutrition programs, substance abuse outpatient services and crisis prevention programs. Residents also provide a disproportionate amount of care to low-income Medicare patients.5 Additionally, more than 37,000 medical

With an impending physician shortage, cutting GME funding is short-sighted and will take physicians out of hospitals.
Despite the predicted shortage of physicians, the amount of available residency slots funded by Medicare has been capped since 1997. At the same time, medical schools are expanding enrollment to meet future needs. As a result, U.S. medical school graduates may exceed the number of available residency slots as soon as 2015.7 Therefore, some will be unable to obtain the training necessary to become licensed physicians, further limiting public access to quality health care. This will happen sooner if GME funding is cut or medical school enrollment exceeds its projected increases. Meanwhile, becoming a physician requires a huge personal and financial commitment; most physicians have undergone 11 to 20 years of education, including undergraduate, medical school, and

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residency training. Therefore, action needs to be taken immediately to preserve and ensure adequate, stable funding for GME since GME has a major impact on the physician-to-population ratio for several decades.

Training residents is beneficial for communities.

The direct cost to train one resident averages over $100,000 per year. With an estimated 110,000 residents in training each year, the direct yearly cost comes to approximately $13 billion.8 Teaching hospitals also incur indirect costs from maintaining institutions that support

clinical research while treating a more complex patient population and providing the specialized services vital to many communities. Thus communities experience a substantial benefit from their investment in physician training.
AMA-supported solutions Ensure GME opportunities for all qualified applicants, including international medical graduates Encourage medical workforce expansion to correct shortages by specialty and geography Ensure adequate, stable funding for core residency programs

1.  AAMC. Medical Student Education: Costs, Debt, and Loan Repayment Facts. 2012. Available at https://www.aamc.org/download/152968/data/debtfactcard.pdf. 2. Ibid. 3.  AAMC. Preserve Medicare Support for Physician Training. https://www.aamc.org/download/262676/data/gmefactsheet.pdf 4.  AAMC. Why Teaching Hospitals Are Important to All Americans. https://www.aamc.org/initiatives/gmefunding/factsheets/253374/teaching-hospitals.html 5.  AAMC. What role to teaching hospitals fulfill? https://www.aamc.org/linkableblob/70248-5/data/teachhospfacts1-data.pdf 6.  U.S. Department of Veterans Affairs. Medical and Dental Education Program. http://www.va.gov/oaa/gme_default.asp 7.  Iglehart, JK. The Uncertain Future of Medicare and Graduate Medical Education. NEJM. 2011; 365:1340-1345 http://www.nejm.org/doi/full/10.1056/NEJMhpr1107519 8.  AAMC. What does Medicare Have to Do with Graduate Medical Education? https://www.aamc.org/initiatives/gmefunding/factsheets/253372/medicare-gme.html 2013 American Medical Assocaition. All rights reserved. AG33:13-0030:PDF:1/13:DF