Since Medicare is the principal source of funding for graduate medical education in the US, a lot of residency programs have witnessed limitations when the economy went sour. Many states look at graduate medical education as a target to cut down their budgets. Consequently, teaching hospitals and academic health centers are now caught in a tight situation between cutting costs and looking for new funding sources other than Medicare. These centers are focusing on finding a solution to maintain their residency programs while they should be expanding them to cope up with the growing number of physicians, the increasing demand from the population, the new advances and technologies in healthcare.
In my opinion, a key issue is not just the funding, but also the government not being in control of the residency positions by specialty. As a result, many physicians became clinical specialists while the healthcare delivery system in the US should be improving primary and ambulatory care practices. In contrast, in the UK, the government finances residency positions and controls the number of slots by specialty. If the US government evaluated which medical specialties need more residents and which do not, then the residency programs will be more efficient and cost effective. Also, if Medicare wasn’t the only main contributor to graduate medical training programs and the government allowed for more entrepreneurs and private companies to help fund these programs under its supervision, the unnecessary cut backs will decrease, hence expanding efficient residency programs that focus on areas and domains that need more physicians. Another consideration should be increasing the grants and scholarships from universities for medical students with excellent performances to enable them to enroll in residency programs in the country or even abroad. Universities could limit the budget that goes to unnecessary facilities and use it to fund residency programs with the help of generous donors and fund raising events. Either way, federal funding, academic hospitals, universities and state legislators should collaborate to avoid any shortages in graduate medical education additional to controlling the number of positions by specialty, which will provide comprehensive medical care in all areas.
