John K. Iglehart, national correspondent of The New England Journal of Medicine, wrote in the past 15 years there has been a payment cap Congress imposed on Medicare's funding of advanced training -- residencies in hospitals -- in the Balanced Budget Act of 1997.
Medicare is the primary supporter of graduate medical education programs, contributing $9.5 billion to fund a share of the costs of 100,000 positions in teaching hospitals and to offset the costs of services that are unavailable elsewhere in the community, such as trauma and serious burn care, the article published in The New England Journal of Medicine.
About two thirds of Medicare's GME support is a payment adjustment for patient care, which was mandated by Congress to "account fully for factors such as severity of illness of patients requiring the specialized services."
Efforts by the Association of American Medical Colleges and its allies to persuade Congress to increase Medicare GME funding for an additional 15,000 positions were thwarted during the debate over the Affordable Care Act.
Newer bills that include a similar increase have been introduced in Congress, but they are long shots, given the emphasis on constraining government spending and a 2014 budget from the Obama administration calling for reducing Medicare GME support by $11 billion over the next decade, Iglehart said.
Given enrollment growth of medical students since the 2000s it might soon be impossible for all graduates of U.S. medical and osteopathic colleges to secure GME slots unless there is a sizable increase in the number of training positions, Iglehart said.