University of Minnesota medical officials warn of crunch in residencies

A national training bottleneck threatens Minnesota's ability to fill increased demand for doctors in coming years, University of Minnesota medical school officials warn.

Stagnant federal and state funding has limited the number of residency positions where they can train. Unless the number of residencies increases Minnesota will be short a projected 2,000 physicians a decade from now, they say.

"If you want to be able to control your workforce and have workforce available in the future, you've got to build your own," said Troy Taubenheim, director of the Metro Minnesota Council on Graduate Medical Education.

Tens of thousands of new patients are expected to flood hospitals in the state over the next decade -- many of them aging Baby Boomers and those newly insured under the Affordable Care Act, according to numbers provided by Taubenheim.

Meanwhile, close to half of the state's physicians will be old enough to retire within a decade. If they do, Taubenheim's figures indicate, under current conditions the state will be able to replace fewer than half of them.

Simply expanding medical school enrollment won't produce enough doctors to fill such gaps because of a training bottleneck, health officials say.

After students graduate from medical school, they can't practice until they receive several years of training in hospitals and clinics -- training known as a residency.

The problem is that the number of residencies is effectively capped by government funding.

The federal Balanced Budget Act of 1997 provides enough money through Medicare for about 26,000 new residency positions nationwide each year -- about 500 of them in Minnesota.

Federal funding covers about two-thirds of the cost of the positions, which can run as much as $150,000 per trainee, Taubenheim said. The rest is split roughly evenly between the state and the hospitals and clinics themselves.

That pool of residencies hasn't changed much over the years because of a lack of increased funding, medical officials say.

So although medical schools have increased their enrollment, the number of residencies has remained mostly the same, which has created a bottleneck.

That bottleneck is what Dr. John Andrews, dean for graduate medical education for the University of Minnesota, calls the "absolutely critical" factor behind the coming shortage.

In October, the U's medical school dean, Dr. Aaron Friedman, told legislators as much.

In a letter to the leaders of the state House and Senate higher-education committees, he wrote:

"Although the demand for physicians and other health professionals is growing, the University has not plans at this time to expand its medical school enrollments. The major bottleneck is the lack of residency training positions and funding in Minnesota and nationally. ... Until these [funding] issues are addressed it makes no sense to increase medical school enrollments. There will be no place to train them."

Andrews said the limited number of residencies could affect future medical students as well.

More than 95 percent of the U's medical graduates get residencies, he said. But as the number of graduates from American and foreign medical schools increases, he said, so would the competition for slots.

"There would be some anxiety about whether people graduating from this medical school will continue to compete at [the current] level," he said.

Most likely, he said, it will be tougher for graduates to get the training slots in the fields they want and in the cities where they want to work.

Expanding the number of residencies could also indirectly help lessen the shortage primary care physicians in the rural parts of the state, state medical officials say.

Other factors such as income do play a much larger role in that primary care shortage. But enlarging the overall pool of doctors overall, they say,  would mean that statistically the number of primary care physicians would rise with it.

To obtain more government funding for training positions, medical organizations have been lobbying at the federal level. Congressional lawmakers have introduced a few bills to expand the number of residencies, and Minnesota cosponsors include Rep. Keith Ellison and Rep. Timothy Walz as well as Sen.  Al Franken.

But Len Marquez, director of government relations for the Association of American Medical Colleges, said the cost of such legislation has made it hard for any of those bills to get much traction. A solution that would generate about half the doctors needed nationally would cost about $10 billion over a decade, he said.

At the state level,  Sen. Terry Bonoff, DFL-Minnetonka, said she's helping put together a group of legislators who'll start looking for solutions to the funding problem next week. Bonoff said they'll try to find a way to increase the state's contribution, or find more federal money.

Traditionally, the state has chipped in about $60 million to fund residencies in Minnesota, though that amount has been subject to budget cuts.

Taubenheim said it would take an estimated $73 million more a year for Minnesota to train the number of physicians it needs.

He says says government support is important if Minnesota wants to keep physicians. About two out of three doctors who train here end up practicing here.

Minnesota wouldn't be the only state to beef up its spending. Florida and Texas, for example, have announced increases to their funding in that area.

Meanwhile, the U is considering ways that nonphysicians -- such as nurse practitioners and pharmacists -- could help relieve the strain. The idea is to have them do some of the work that medical doctors normally do.

The idea of increased government funding for residencies does have its skeptics, says health economist Gail Wilensky. And many of them would argue that hospitals could do with less.

The way many of them see it, she said, hospitals derive a lot of revenue from the work of poorly paid residents -- and so should probably pay more of the cost of residencies.

"Monies are going to the hospital," Wilensky said. "But ... the resident is the one paying for this training by working 80 hours a week for which they get paid a salary of about $40,000-$45,000 a year. "

State Rep. Gene Pelowski also said that the U could help solve the problem by using some of the savings from its recent round of cost-cutting to pay for more residencies.

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