States and schools have responded to the need by increasing the number of medical students, but that alone will not increase the supply. The unwillingness of Congress to fund additional Medicare GME positions may lead to U.S. medical school graduates who lack opportunities to complete their residencies, Grover says.
Just last March, 528 qualified 2013 medical school graduates were not matched to a residency training position, 758 qualified medical doctors who had graduated prior to 2013 also failed to be matched.
"I can boost enrollment in an MD [academic] program until the cows come home. If I don't train them after they receive their degrees, it's worthless. You can't practice until you are matched into a residency as a trained and licensed physician," Grover says.
"They can go into industry, but they can't take care of patients. No physician, no MD, or DO can practice anywhere in the country without doing a residency. They can work for industry or research, but our goal is to have as many out there to take care of patients," he says.
Since 1965, Medicare has been the largest supporter of graduate medical education programs and has paid for its share of training costs. Then the Balanced Budget Act of 1997 imposed a cap on Medicare funded-GME at 1996 levels. This came at a time, he says, that managed care seemed to be the future of the healthcare systems.