The COVID-19 pandemic is putting additional stress on the program that matches medical school graduates to residency programs, further straining the supply of trained physicians, a new study finds.
The pandemic has caused a great deal of disruption in medical school training, the study found. Students have been unable to take timely medical licensing exams, which has caused particular delays for students in foreign medical schools. Medical schools cut back on clerkships, rotations, and other opportunities for students to bolster their applications.
The JAMA Network article, published on June 3, says the gap should provide an excellent opportunity to bring much-needed reforms to the system.
Study authors Maya M. Hammoud, M.D., MBA; Taylor Standiford, B.S.; and J. Bryan Carmody, M.D., M.P.H. suggest adjusting the residency application timeline, modifying application requirements, using a more holistic review of applicants, limiting the number of applications, expanding information to applicants to help them make better application choices, capping the number of interviews a student can accept, and allowing graduates to find residencies outside the National Residency Matching Program.
More Graduates, Fewer Residencies
This year, 40,084 medical school graduates applied for 37,256 residencies, according to the National Resident Matching Program. Applicants from U.S. medical schools apply to an average of 65 programs while international students exceed that number by more than double.
The federal government, through Medicare, funds residencies under a cap set by Congress in 1997. Under the Resident Physician Shortage Reduction Act of 2019, Congress proposes to fund 15,000 new residency positions over five years beginning in 2021.
Trends suggest action. In its annual report released June 26, The Association of American Medical Colleges (AAMC) predicts the U.S will be short 139,000 physicians by 2033, of which primary care physicians will comprise up to one-third of that shortage.
Ending the cap on residency funding is a key to eliminating the shortage, says Rebekah Bernard, M.D., a board member of Physicians for Patient Protection.
“One of the biggest issues is that there has been a freeze on residency funding, and therefore spots, since 1997,” said Bernard. “The ACA [Affordable Care Act] of 2010 did nothing to expand physician training while increasing funding for the training of non-physicians such as nurse practitioners and physician assistants. We have thousands of graduating medical students, both U.S.- and foreign-trained, who are unable to match every year because of the lack of spots. The only way residency spots grow is through funding, which has traditionally been through Medicare funding of hospitals.”
The shortage of spaces in residency programs means medical school graduates cannot satisfy the licensure requirements to practice in many states. Allowing these graduates to work while waiting for the next residency cycle could help alleviate some of the pressure on the medical system, says Bernard.
“Some states have incorporated an ‘assistant physician’ program that allows unmatched medical school graduates to work under physician supervision while they await the next year of residency applications,” said Bernard. “Missouri has led the way in this. It’s been controversial among physician leadership, with some seeing it as a way to get unmatched graduates an opportunity to get some experience, while others fear that it will create a sort-of lower level physician.”
Missouri offers an assistant physician program which allows unmatched medical school graduates from the U.S. and abroad to practice under the supervision of a licensed physician.
Trent Schmale, D.O. was finishing his third year as a family medicine resident when the coronavirus pandemic hit. His training changed dramatically.
“During the start of the COVID outbreak, my residency severely cut who we were seeing in the clinic,” said Schmale. “We only saw obstetric patients, kids that needed vaccines, and acute problems in non-high-risk groups of people that didn’t have COVID symptoms.”
Numerous patients were transitioned to virtual visits or to home visits if they were in a high-risk group and did not have access or the ability to use technology. Those methods could be expanded to residency programs, says Schmale.
“As far as changes going forward in the residency programs, it would be great to see telemedicine playing a larger role during training,” said Schmale. “This is going to continue to become a larger part of health care in the future, and it already was big in certain areas of private health care like direct primary care clinics. I also foresee home visits becoming a larger part of training again, due to COVID not going away anytime soon and not wanting to expose high-risk patients who don’t have the access to a computer, smartphone, or other devices.”
Kelsey Hackem, J.D. (firstname.lastname@example.org) writes from the state of Washington.
Maya Hammoud, M.D.,MBA, Taylor Standiford, B.S., Bryan Carmody, M.D. MPH, “Potential Implications of COVID-19 for the 2020-2021 Residency Application Cycle, JAMA Network, June 3, 2020: https://jamanetwork.com/journals/jama/fullarticle/2766944?resultClick=1