It's Academic

April 2015 


2015 Residency Match Largest Ever, But More Programs Needed

The 2015 Main Residency Match was the largest ever for allopathic programs, reaching all-time highs in numbers of registrants (41,334) and positions offered (30,212), according to the 2015 National Resident Matching Program (NRMP) report released last month.

A record 27,923 first-year residency positions were offered this year, and more than 600 were new. Half of the new first-year positions were in the primary care specialties of family medicine, internal medicine, and pediatrics.

Of the 41,334 registrants, 2,941 withdrew and 3,488 did not submit a list of programs ranked in order of their preference, leaving 34,905 active applicants competing for 30,212 positions.

New medical schools and rising enrollments brought 651 more allopathic U.S. senior applicants this year than last, and a record number of them (16,932), along with 9,000 other applicants, matched to one of the 27,923 first-year residency positions. 

The overall match rate for U.S. allopathic seniors was 93.9 percent, with 500 more matched this year than last, and 51.6 percent matched to their first choice for training.

More than 79 percent of the 2,949 active applicants who were students/graduates of osteopathic medical-schools matched to first-year positions. 

Match rates for international medical graduates (IMGs) remained among the lowest of applicant categories. Fewer than 50 percent of the 7,366 non-U.S. citizen IMGs matched to first-year positions (49.4), and 53 percent of the 5,014 U.S. citizen IMG applicants matched. 

View the 12-page Advance Data Tables for the 2015 Main Residency Match from NRMP. 

Match results are predictive of future changes in physician workforce supply, which, at current rates, will not keep up with demand. While medical school enrollment is growing by about 2 percent per year, the number of residency positions is growing by less than 1 percent per year, according to the Association of American Medical Colleges. 

This graduate medical education (GME) bottleneck is already becoming acute in Texas, and residency shortages will continue to hinder meeting the increasing demand for physicians as the population grows in Texas. 

Medical school enrollment has grown by 31 percent over the past decade in Texas, while entry-level GME positions grew by 26 percent. According to Rodney B. Young, MD, chair of TMA’s Council on Medical Education, this discordance will result in a GME bottleneck that will force more Texas medical school graduates to leave the state and find residency programs elsewhere, taking the state’s investment in their medical education with them.

“Each year, almost half of Texas medical school graduates leave the state for residency training,” Dr. Young said. “State funding for GME is absolutely critical for the continued efforts to expand GME training.

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New Study Predicts Dire Shortage of Physicians in 10 Years

A new study released last month predicts that in just 10 years, the United States could face an acute shortage of 46,000-90,000 physicians as a demand driven largely by aging baby boomers steadily overcomes supply. A 4-percent increase in demand for outpatient primary care as a result of the Affordable Care Act will be overshadowed by a 14-percent increase from our aging demographic, the study estimates. Because older adults require more health care and a greater percentage of specialists, they are expected to drive a 23-percent increase in hospital inpatient care. 

Although shortages are projected in primary care and specialty care, the shortages in specialty care will be more severe, according to the report.

The Association of American Medical Colleges (AAMC) commissioned the Life Science division of IHS Inc., to conduct the study, and describes it as the first comprehensive national analysis that takes into account both demographics and recent changes to care delivery and payment methods. 

A variety of future health care delivery and policy scenarios were considered in projections, including the rapid growth in nonphysician clinicians and new payment and delivery models such as patient-centered medical homes and accountable care organizations.

Under every likely scenario, the physician shortage will grow over the next 10 years, according to Darrell G. Kirch, MD, AAMC president and CEO. “The trends from these data are clear,” Doctor Kirch said. “The doctor shortage is real — it’s significant — and it’s particularly serious for the kind of medical care that our aging population is going to need.”

Projections for individual specialties were aggregated into four broad categories: primary care, medical specialties, surgical specialties, and other specialties. Within the overall projected physician shortage, the study estimates a shortage of 12,000-31,000 primary care physicians, and a shortfall of 28,000-63,000 nonprimary care physicians, most notably among surgical specialists.

AAMC says the solution requires a multipronged approach.

Reforms alone will not eliminate the shortage, according to AAMC, which is urging Congress to provide additional federal support to train at least 3,000 more doctors a year by lifting the cap on federally funded residency training positions. Though medical schools have expanded enrollment to address shortages, residency positions have not increased at the same pace. 

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GME Boost, Tax Relief in Sight This Session

Graduate medical education (GME) expansion is TMA’s top priority this legislative session, and TMA leaders are pushing for increased state dollars to expand GME capacity. The House of Representatives voted last week to finalize its version of the 2016-17 state budget, and the Senate is expected to take action on its draft budget next week.  Both chambers’ proposals add funding for GME, as well as women’s health care and mental health care services.  

GME and primary care workforce development stand to get a significant boost: The House bill adds roughly $24 million, and the Senate proposes an additional $62 million. It will be up to a conference committee to work out the differences.  

Meanwhile, Senate Bill 18 by Senate Finance Committee Chair Sen. Jane Nelson (R-Flower Mound) proposes a set of GME expansion programs that would put that budget money into action to reach a goal of 1.1 slots per medical school graduate. The Senate Finance Committee adopted a proposal for $41 million to implement the GME expansion provisions in SB 18 and an additional $19 million in support of primary care workforce development programs, including the Family Medicine Residency Program and Statewide Primary Care Preceptorship Program. 

TMA is monitoring the bill to make sure it addresses critical physician shortages across specialties without unnecessarily complicating the GME funding process.  

On the House side, an increase of 14 percent has been proposed for the state’s GME formula funding program, to take it from the current $70 million to $80 million in the 2016-17 biennium. These monies are intended to help offset training costs for residents. The Senate, at this writing, proposes $86 million for GME formula funding. 

The House budget bill also adds to the Texas Department of State Health Services budget for programs in infectious disease prevention ($20 million), tobacco cessation ($10.7 million), primary care and women’s health care ($20 million), and neonatal drug abstinence ($17 million). 

However, leaders in the upper chamber stepped out first with their expected push for a tax relief package. Senator Nelson, Lt. Gov. Dan Patrick, and Sen. Charles Schwertner, MD (R-Georgetown), unveiled a proposal that contains $4.6 billion in property and franchise tax cuts and consists of three bills: Senate bills 1 and 7 by Senator Nelson and Senate Bill 8 by Senator Schwertner. A House proposal is not far behind. 

More relief for physicians could be on the way thanks to Sen. Kevin Eltife (R-Tyler), who filed Senate Bill 765 to eliminate the $200 annual occupation tax on physicians and other Texas professions. Physicians are subject to both the franchise tax and the occupation tax, and TMA maintains the double tax is not appropriate.  

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SGR Cuts Began April 1, Will Last If Senate Doesn’t Act   

Because Congress adjourned last month before patching or repealing Medicare’s Sustainable Growth Rate (SGR) formula, a 21-percent Medicare pay cut automatically became effective April 1, and will remain in effect, at a minimum, until the U.S. Senate returns from its two-week break on April 13. 

The U.S. House of Representatives, led by Rep. Michael Burgess, MD (R-Texas), overwhelmingly passed the Medicare Access and CHIP Reauthorization Act on March 24. The Senate, however, left for its Easter recess without acting on the legislation. Senate Majority Leader Mitch McConnell (R-Ky.) has pledged to take up the bill quickly when senators reconvene. 

According to the American Medical Association, the Centers for Medicare & Medicaid Services has told its carriers to hold for 10 business days any claims received for services provided on April 1 and beyond until Congress resolves the matter. The 10-business-day hold means that April claims will be held through Tuesday, April 14. Because, by law, no claims can be paid sooner than 14 calendar days from their receipt, this hold should have little practical impact on Medicare remittance in the short term, although billing for copayments and claims reconciliation will be more complicated. 

If Congress allows the 21-percent cut to stand, Medicare would pay physicians at the reduced amount no matter what the physician billed, and no further action would be necessary. However, nonparticipating physicians who have collected balance-billing amounts for unassigned claims based on the currently allowed amount could be required to make refunds to their patients based on new, lower balance-billing limits. 

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New Grant Program Seeks to Expand Stewardship in Medical Education and Training

The ABIM Foundation announced a new grant program last month to promote stewardship in clinical training programs in medicine, nursing, and other allied health professions. The ABIM Foundation will award six grants this year of up to $25,000 each to medical schools and other training programs for projects that instill stewardship competency in their students, including training on the negative consequences to patients’ physical and financial health of overused and possibly unnecessary tests and treatments. 

Through the new grant program, called Putting Stewardship into Medical Education and Training, the ABIM Foundation hopes to encourage and implement innovative and scalable practices or ideas for integrating stewardship as a defined competency and professional norm in medical training.  

Grant applications are due May 18. 

View the request for proposal or download application instructions from the ABIM Foundation website

Foundation staff will answer questions about the grant during a conference call set for Tuesday, April 14, from 1 to 2 pm (CDT). Call (888) 289-4573 to join the call, and enter participant code 6009381#. 

The ABIM Foundation initiated the national Choosing Wisely® campaign that encourages physicians and patients to talk about treatment options with a mind toward reducing unnecessary care. Since Choosing Wisely began in 2012, more than 60 medical specialty societies each have identified, through evidence-based research, their specialty’s top five overused tests or procedures that may not always benefit patients.  

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Come to TexMed 2015 — FREE for All TMA Members!

Register today for TMA’s free annual conference, and join thousands of your fellow Texas physicians as TexMed 2015 arrives in Austin May 1-2 for a weekend of advocacy, education, and collaboration. 

TexMed is TMA's largest event of the year, offering free continuing medical education (CME), an extensive gathering of exhibitors to help with every aspect of your practice, and, because we’re in Austin, a special Thursday event at the Capitol.

At TexMed 2015, you can meet with elected officials face-to-face to voice the priorities for medicine this legislative session, participate in your choice of more than 80 hours of free CME including two general sessions, and mingle and network with your colleagues from across the state. There’s nothing quite as impactful as thousands of Texas physicians coming together in one place to form one unified voice.

The latest in your colleagues’ quality improvement initiatives will be on display during the third annual TexMed Poster Session, with an author-hosted walk-through on Saturday, May 2, from 8 to 9 am. Categories were expanded this year to offer physicians and medical practice staff more opportunities to participate.

See all the details and register for TexMed.

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TMA: A Physician's Strongest Advocate

 TMA’s Healthy Vision 2020, Second Edition, articulates in detail what we are asking of the Texas Legislature, the U.S. Congress, and state and federal regulators. 

TMA has been a longtime advocate for academic faculty and medical schools, monitoring legislation, determining the potential impact to patients, and actively lobbying for your interests. Only with grassroots support can we make sure Texas remains a premier state in the education of future physicians, in research, and in quality patient care. 

Join or renew today. Within your department or academic institution, funds may be available to cover the cost of your membership. Please check with your department administrator or chair. 

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This Month in Texas Medicine

The April issue of Texas Medicine guides you through the what, when, why, and how behind Medicare value-based care; examines the educational and workforce benefits of resident moonlighting; discusses a Texas court case in which the telehealth provider Teladoc argues a face-to-face meeting is unnecessary for new patients; explains the proposed health service enterprise gateway, which would give physicians a single place to exchange data with all state health agencies; and introduces Ira Byock, MD, who will speak at TexMed's General Session in May about providing the best care possible at the end of life. 

Check out our digital edition.

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It's Academic is for physicians in academic settings. For more information about TMA’s efforts on behalf of medical education and academic physicians, visit the TMA Council on Medical Education’s Subcommittee for Academic Physicians page and Advocacy page on the TMA website.

Please share with your colleagues who are not TMA members and ask them to join.

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    The State legislature is unable to support the existing medical schools adequately. Another institution, no matter where it is located, would put more unnecessary strain on already stretched finances. Find the money to treat the ones you have better before straining draining resources.
    William E. Powell, M.D.

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