By: Julius W. Hobson, Jr.

The COVID-19 pandemic revealed to Federal public policymakers and the general public the need for more health care providers. More importantly, there was a greater realization of a shortage in underserved areas, particularly in certain urban, rural, and Native American settings.

On May 20, the Senate Committee on Health, Education, Labor and Pensions Subcommittee on Primary Health and Retirement Security, chaired by Senator Bernie Sanders (I-VT) held a hearing on “A Dire Shortage and Getting Worse: Solving the Crisis in the Health Care Workforce”.

Dr. David J. Skorton, President & CEO, Association of American Medical Colleges (AAMC), stated that physician demand will grow faster than supply, leading to a projected physician shortage between 54,100 and 139,000 by 2033. AAMC projects:

• A shortage of primary care physicians between 21,400 and 55,200 by 2033.
• A shortage of non-primary care specialty physicians between 33,700 and 86,700 by 2033, including:
  • Between 17,100 and 28,700 for surgical specialties.
  • Between 9,300 and 17,800 for medical specialties.
  • Between 17,100 and 41,900 for the other specialties category.

Dr. Skorton said AAMC recommends doubling funding for the Health Resources and Services Administration (HRSA) workforce development programs under Title VII and Title VIII of the Public Health Service Act. Under Title VII, AAMC supports increased federal funding for the HRSA Title VII Primary Care Training and Enhancement (PCTE) and Medical Student Education programs.

Dr. Leon McDougle, President of the National Medical Association (NMA) spoke about primary cost savings and improved health disparities outcomes. He called for additional Graduate Medical Education (GME) residency positions to support training of primary care residents/fellows who agree to a service obligation in Health Professional Shortage Areas or Medically Underserved Areas or Populations after completion of residency/fellowship training. He said priority should be given to funding more primary care GME positions for hospitals within rural and urban health professional shortage areas of medically underserved areas and populations. 

Dr. McDougle also suggested expansion of the number of National Health Service Corps Scholarships and provide additional incentives for physicians to remain in the community once their obligated service time has expired.

Shelley Spires, CEO, Albany Area Primary Health Care, testified on behalf of the Association of Clinicians for the Underserved (ACU). She spoke to the need to ensure greater racial and ethnic diversity of the health care workforce as essential for increasing access to culturally competent care for all of the nation’s communities. She, too, spoke to the need to provide greater funding for the National Health Service Corps. Among her recommendations Ms. Spires suggested:

• Support the creation of state loan repayment programs in all states and territories with dedicated funding to enhance workforce recruitment and retention on a state-by-state basis.
• Consider expanding the Department of Veterans Affairs (VA) approach and policy to redeploy workforce to areas of need via telemedicine, apply the same concept to support areas of higher need for the underserved.  She spoke to the issue of cross-state licensure.

James D. Herbert, PhD, President, University of New England, suggested five specific strategies:

• The need to increase the number of doctors, nurses, and other healthcare professionals educated.
• Intentionally recruit more students who look like the communities needed to be served.
• Encourage newly trained health professionals to practice in underserved areas following graduation, such as in rural, medically underserved, and tribal communities.
• Leverage the power of technology to reach underserved communities.
• Citing the 2001 Institute of Medicine report Crossing the Quality Chasm: A New Health System for the 21^st Century, he called for a fundamental change the prevailing educational model.

During the hearing, Chairman Sanders announced his intention to introduce the “Addressing the Shortage of Doctors Act”. The legislation would do the following:

• Authorize 14,000 new Medicare-supported medical residency positions over seven years (from 2023-2029, with 2,000 allotted per year).
• Establish new criteria for how the new GME training positions would be allotted at qualifying hospitals with a minimum of 50% of new slots going towards primary care (which can include mental health).
• Require CMS to distribute at least 25% of the slots to each of the following categories of hospitals: 1) hospitals in rural areas and 2) hospitals that serve areas designated as health professional shortage areas (HPSAs).
• Require hospitals receiving funding from the program to create pay parity between primary care residents and specialty residents. The average resident earns about $63,000, but it varies between specialties. Survey data shows primary care residents earn about $58,000, and at the high end are rheumatologists at $69,000.
• Require that regardless of specialty all residents under the program complete a primary care rotation.
• Make permanent the Teaching Health Center GME program (currently authorized through FY23) and increase funding for the program.
• Increase funding for the National Health Service Corps by $1 billion per year for ten years.
• Increase funding for the National Health Service Corps by $1 billion per year for ten years.

It remains to be seen, what if anything, Congress will do to meet this pressing problem. As any health care professional is aware, knowledge of the future shortage of health care professionals has been very clear.