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How Innovations in Medical Training Matter in an Era of Budget Cuts and Physician Shortage

This article originally appeared on The American Resident Project, a platform for future physician leaders to connect and explore ideas. 

The shortage of primary care physicians in the United States has been long discussed with an air of impending doom. With the cost of medical education steadily rising, the reimbursement of general practitioners gradually dwindling and the Affordable Care Act introducing a whole new population of patients to the system, the heaviness of that conversation seems to grow every day. 

work-force report released by the AAFP in 2006 displayed the current number of family practice physicians in each state, along with each state’s projected need in 2020. With almost every state having a significant disparity, and some with a disparity so large it was jarring, time marched on. Fast-forward to 2014 and we’ve seen an increase in the number of U.S. medical school graduates, but no comparable increase in the number of funded residency spots available and no meaningful increase in the percentage of those graduates going into primary care. 

A pilot program started by Texas Tech School of Medicine in 2010 created an accelerated track called the “F-MAT” program where students with a goal of serving in primary care could obtain their doctor of medicine in three years rather than the traditional four. Not only does this program speed up time to graduation, but it significantly reduces student loan debt by pairing scholarships with shorter training. 

While concerns have been voiced over the effectiveness of this method of training, I personally think the curriculum is not only appropriate, but beautifully coordinated. By instating more programs like this, we could not only reduce the cost of medical education but also potentially work to improve the current state of U.S. health care. 

The issue of funded residency spots, however, still stands. In recent years there’s been almost $11 billion (!) in budget cuts to graduate medical education. At my hospital, that has directly translated into the disappearance of almost 15 residency positions for the 2015 NRMP match. What that means for the future, particularly if this trend continues, is more and more U.S. medical graduates with all the debt and sacrifices that come with medical education but without the job they need to pay it back.

As it stands now, it seems that U.S. medical training programs are doing their best to address the physician shortage, but they have not received the support and funding needed to actually make a dent in the problem. So, how do we fix it? I don’t know what the right answer is, but I think we can all agree increasing medical school matriculation while simultaneously cutting residency positions and GME funding is not it. I applaud those in support of innovations like the F-MAT program and hope to see others following in their footsteps in the near future.


The American Resident Project, sponsored by ThinkWellPoint, is a platform for future physician leaders – medical students, residents and physicians newly in practice – to connect, explore ideas for transforming American health care delivery, and exchange their views with other health care providers and opinion leaders across the country.

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