HEALTH CARE

In order to solve the shortage of doctors, we must create a new route to residency.

The medical education system is in crisis. The American Association of Medical Colleges (AAMC) predicts that by 2034 there will be a shortfall of 37,800 to 124,000 doctors in both primary and specialty care. This shortage is particularly pronounced in rural areas and communities serving marginalized populations.

In the face of both the stress of a growing population and an increasing number of retiring doctors, action must be taken to secure the future of America’s healthcare. We call on the US House of Representatives and Senators to pass the Medical Residents Act (HR 8131) to increase competition. This eliminates the antitrust exemptions granted to medical graduate residency matching processes and allows for alternative certification pathways.

Current policy is like putting a band-aid on a bleeding artery. All medical graduates are required to secure a residency position to practice medicine in their eventual chosen specialty. However, there are not enough resident positions to keep up with the number of graduates.

Through the Resident Physician Shortage Reduction Act, Congress sought to add resident physicians in about 2,000 positions annually from 2023 to 2029. However, this increase will not be enough to eliminate the dramatic shortage of doctors.

In 2022 alone, thousands of U.S. graduating medical students will have unparalleled results through the National Resident Matching Program (NRMP) matching system to find an open job, switch to another specialty, or It effectively prevented them from practicing medicine unless they reapplied the following year. In addition to U.S. medical students, approximately 3,000 international medical graduates are currently not practicing because they cannot secure residency through the matching system. In both cases, the match system stands out as a target for change because it plays a major role in preventing qualified medical graduates from independently practicing medicine. In a world reeling from the aftermath of a pandemic, this is intolerable.

So what are the barriers to policy change around the Match system? Based on the almost 20-year-old law, the Match system is immune to antitrust litigation. In 2002, Jung v. AAMC found that the AAMC, NRMP, and many major academic institutions “illegally restricted market competition for resident physician services,” eliminated the ability of residents to negotiate salaries, and prohibited certain programs. Alleged that it violated antitrust laws by coercing people to participate in or participate in the program. place. The lawsuit ended when Congress passed legislation in his unrelated 2004 Pension Fund Act exempting these organizations from antitrust laws based on the unique nature of medical training.

Antitrust laws prevent market monopoly and competition suppression. This is exactly the control the matching system exercises over medical graduates. The introduction of HR 8131 is not intended to abolish the coincidence system, but rather to abolish federal antitrust exemptions by the AAMC and NRMP, subject to the same set of laws as other agencies of their kind. and may allow alternative authentication pathways.

Few current laws provide specific practices that the NRMP and AAMC must follow. Rather, these organizations are responsible for passing their own laws that apply to the stakeholders who use their services. Examples of stakeholders in this group include medical students, residents, medical schools, and residency programs. In addition, the AAMC often endorses and makes recommendations for some of the relevant legislation, as seen in the Approval of the Resident Physician Shortage Act and the Act to Protect 340B Hospitals.

Currently, there are limited alternatives to traditional authentication. However, they do exist. To address the growing doctor shortage and its disproportionate impact on rural areas, Missouri implemented his Assistant Doctor Program in 2014, giving unparalleled medical graduates the opportunity to study under the supervision of a licensed doctor. We provided an opportunity to practice medicine as an assistant doctor. After three years of supervised practice, assistant doctors are eligible to participate in traditional residency programs.

The initiative has met with some controversy due to its unconventional approach, but it also set the groundwork for change. This will allow Missouri assistants to apply for a full license after five years of supervised practice. Although the bill itself is promising, it was scrapped after a committee discussion in 2021. Several provisions have been split into separate bills that are not currently listed for discussion on the House calendar, and despite the increasing need for solutions, their priorities are relative. This indicates that the

Signing HR 8131 into law may be the missing piece needed to revitalize this law not only in Missouri, but in other states as well. With the Match program’s special antitrust exemption removed, the investigation of alternative certification pathways moves from theory to practice. Stakeholders recognize the need to enable all medical graduates to practice medicine, opening the door to new possibilities for alleviating the physician shortage crisis.

This parallel implementation path is not without its challenges. After all, the matching system is the process that has shaped and evolved the flow and evolution of medical students into residents for over 70 years. This means building a program from scratch while ensuring adequate training for residents. This may cause alternative certification paths to be viewed as inferior or uncompetitive. In contrast, they fail to attract qualified applicants who do not want their training to be seen as inferior, or they can degrade the quality of health professionals by truly training them. There is a nature. unsuitable for practice.

However, it is important to recognize that the challenges associated with repealing antitrust exemptions are not sufficient to oppose their repeal. Given the lack of significant reforms to AAMC/NRMP in the last few years, the system is ripe for an overhaul. We have many qualified medical professionals sitting on the sidelines, pouring into an overloaded curing system.

Aamir Hussain is a resident physician in Washington, DC. Umayr Shaikh, a medical student at Georgetown University, helped create this story.

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