NJ Exceeds National Average for Medical Residents, But Problems Remain

Andrew Kitchenman | November 6, 2013 | Health Care
National study points to outdated system for filling hospital spots while state expert calls for new approach

Deborah Briggs
New Jersey may have more medical residents than the national average, but a national study points to problems that an outdated system causes for the state.
The study, published in the journal Health Affairs, found that New Jersey ranks 15th among the states in the number of medical residents it has per 100,000 population.

With a federal cap of 29.31 medical residents per 100,000 people, New Jersey is slightly above the national average.

But the report points out problems with the national system of allocating Medicare funding to pay for residency slots. A 1997 federal law caps the number of residency positions at each hospital, leaving some hospitals in New Jersey with a limited number of young doctors training to meet the state’s future heathcare needs.

While the number of medical residents “is pretty well-matched to the population of New Jersey, the question always is, what does that mean for your workforce,” said study coauthor Dr. Candice Chen, an assistant research professor at George Washington University’s School of Public Health and Health Services.

The federal government pays for most funding for medical residencies. By capping each program at the same number as they had in 1997, there is limited flexibility to address changes in the healthcare landscape.

Chen noted that northeastern states like New Jersey train relatively few primary-care doctors, particularly at hospitals affiliated with medical schools. With a larger share of medical residents focusing on various other specialties, these states end up with healthcare systems geared more toward inpatient care. This in turn can raise the cost of healthcare.

Chen noted that a separate study she worked on earlier this year found that, from 2006 to 2008, many of New Jersey’s largest residency programs had a small number of primary care residents. An online tool provides summaries of each of these graduate medical education (GME) programs.

“You look at these big GME programs and you got to start to ask, ‘Are they producing the doctors that you want them to produce?’ ” Chen said, adding that they run the danger of subsidizing teaching hospitals rather than focusing on future healthcare needs. While she said the hospitals are responding to the incentives that the federal government has provided, “the problem is, we’ve so closely linked our graduate medical education to a focus on hospitals that they’re not ready to staff the primary care.”

Chen noted that many of New Jersey’s smaller hospitals are focused on primary-care education for their medical residents, but the 1997 law limits the number of residency positions that they have.

She pointed to the example of a small hospital focused on primary care.

“As a state you might say, ‘Gosh, we really need more doctors in that area; the most intelligent thing we could do is train more doctors at that program so they could stay in that area,’ ” Chen said, but then added: “Medicare wouldn’t fund it.”

Deborah S. Briggs, president and CEO of the New Jersey Council of Teaching Hospitals, pointed out another challenge detailed in the new report. While New Jersey is above the national average in the number of medical residents, it’s at a competitive disadvantage with its neighboring states of New York and Pennsylvania.

New York leads the country with a cap of 77.13 medical residents per 100,000 people, while Pennsylvania is fourth with 54.48.

“That can be a disadvantage for us,” Briggs said, noting that residents may choose to pursue their training elsewhere.

Briggs said the rapid changes in the healthcare system, including the expected increase in the number of patients newly insured under the 2010 Affordable Care Act, make it difficult to foresee where medical residents will be needed in the future.

“I do believe that ultimately there is probably on some level a need for redistribution,” of residents from programs in areas that are well served to areas with fewer new doctors, Briggs said.

The study’s authors recommend that a new national body be given the power to make decisions about where federal funding for graduate medical education will be spent.

However, Briggs said it’s more important to develop such bodies at the state level, adding that a “top-down” approach from a national body would be disastrous to states trying to address their unique needs. She noted that Georgia’s state government has provided money for a state-level organization to fund new medical residency positions, which she sees as a potential model for New Jersey.

But Briggs said numerous visits to lobby members of Congress have taught her that there won’t be any additional federal funding for medical residencies any time soon.

“It’s not going to happen — they’re not going to expand the number of residency slots,” Briggs said, adding that this situation means New Jersey must find other ways to improve the system for training doctors.

“We as medical stakeholders have to come up with other avenues to improve the system beyond saying, ‘Poor us, we’re not getting the resources we need,’ ” Briggs said.

Briggs has been working on other ways to improve graduate medical education.

One approach could be to blend the medical school experience with residency training. She noted that students who started medical school this fall and who have three-year residencies will complete their training in 2020.

If the stakeholders aren’t focused on “the attributes of the physician of 2020, then we’re doing ourselves a disservice,” Briggs said.