Howdy folks. Today we’re talking with Lawson Mansell of the Niskanen Center about why we don’t have more physicians in America and answering listener feedback about subsidizing drug innovation.
Lawson is the author of Healthcare Abundance: An Agenda to Strengthen Healthcare Supply, a recent report detailing worthy changes to the often-neglected supply side of America’s healthcare system.
Lawson walks us through Medicare’s Graduate Medical Education (GME) cap, established in 1997, which limits the number of residency positions that Medicare funds at teaching hospitals. Aside from a recent increase in 2021 of 1,000 new slots, the number of Medicare-funded residency slots has been frozen at 1996 levels for decades.
Doctors in America are required to complete an accredited residency program in order to obtain a medical license. A shortage of residency slots means even qualified medical school graduates cannot complete their required residency training without an available position.
We discuss the legislative history of how the system developed, what is keeping it in place, and what kind of reforms might be able to increase the number of physicians in America without breaking the budget.
What’s in the Episode
[0:23] - Introducing our guest Lawson Mansell, health policy analyst at the Niskanen Center and author of Healthcare Abundance: An Agenda to Strengthen Healthcare Supply.
[1:10] - An overview of Lawson’s report on improving the supply of healthcare in America
[3:32] - Why aren’t there more physician-owned hospitals?
[6:37] - What is standing in the way of America creating more physicians?
[8:19] - The importance of residency programs on the limit of new physicians
[10:09] - What it takes to become a doctor in the United States
[11:30] - How the system has changed since the 1970s
[12:19] - How the government determines how much to pay for the residency system
[13:38] - Why did the government believe in the 1980s that we were going to have too many doctors?
[16:20] - A discussion of the cap on the number of residency slots that Medicare pays for
[19:00] - Do we solve the problem by just increasing Medicare funding for residency slots?
[21:00] - The residency payment mechanism, determined by DME and IME payments, should probably be re-evaluated
[23:18] - Details about the policy proposal to change the residency funding into a uniform per-resident amount
[27:33] - Discussing international medical graduates
[34:50] - Overcoming resistance by interest groups
[37:07] - Listener feedback inspired by Episode 1: If negotiating prescription drug prices downward negatively affects innovation, shouldn’t we be paying much more for prescription drugs? Where is the line?
[42:49] - Veto of the week: “An act for the promotion of anatomical sciences and to prevent the desecration of graves.”
[44:38] - Send us your feedback or policy questions by emailing feedback@584vetoes.com or finding me on Twitter @TomVChurch
Relevant Sources and Numbers from the Episode
Healthcare Abundance: An Agenda to Strengthen Healthcare Supply
Health Affairs article on the ACA’s effect on the formation, expansion and operation of physician-owned hospitals
SSRN paper on reconsidering the ban on new physician-owned hospitals
Senator Lankford bill to reintroduce physician-owned hospitals
AAMC report projecting shortage of 86,000 physicians by 2036
CMS pays about $180,000 for one residency slot at a hospital
1981 Graduate Medical Education National Advisory Committee (GMENAC) report predicting a surplus of 70,000 physicians by 1990
Recent increase of 1,000 new residency slots in legislation
2020 forecast of the physician workforce shortage in the United States by state
Robert Orr’s report “Unmatched: Repairing the U.S. Medical Residency Pipeline”
Migration Policy Institute report on the number of available immigrant doctors and medical professionals
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