Candice Chen of the National Institute on Minority Health and Health Disparities; Imam Xierali of the Association of American Medical Colleges; Katie Piwnica-Worms, a third-year medical student at Jefferson Medical College at Thomas Jefferson University; and Robert Phillips of the American Board of Family Medicine said that out of 304 hospitals receiving additional positions, only 12 were rural, and they received fewer than 3 percent of all positions redistributed.
Graduate medical education is the system to train interns and residents in their chosen specialties and costs the government nearly $13 billion annually. However, there is little accountability in the system for addressing physician shortages in specific specialties and geographic areas, the researchers said.
Medicare provides the bulk of GME funds, and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 redistributed nearly 3,000 residency positions among the nation's hospitals to train more residents in primary care and in rural areas.
"Although primary care training had net positive growth after redistribution, the relative growth of non-primary care training was twice as large and diverted would-be primary care physicians to sub-specialty training," the researchers wrote in the study. "Thus, the two legislative and regulatory priorities for the redistribution were not met."
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which created the drug program Medicare Part D, also gave an extra $25 billion to rural hospitals at the request of congressional representatives in the rural West.
The findings were published in Health Affairs.
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