States with the Fewest Residents Slots Available

New research has revealed the imbalances in distribution of Medicare graduate medical education (GME) money and state-by-state caps on resident slots.

Although enrollment in medical schools is on the rise, organizations have voiced concerned that it still won’t be enough to fight the physician shortage because there aren’t enough graduate medical education slots available for residents.

In a Health Affairs report, authors Fitzhugh Mullan, Candice Chen and Erika Steinmetz found large differences between states in the number of Medicare-sponsored residents per 100,000 people by analyzing Medicare cost reports from teaching hospitals.

“Medicare GME payments — which represent the largest single public investment in health workforce development — are allocated based on an inflexible system whose rationale, effectiveness, and balance are increasingly being scrutinized,” the authors wrote.

The average pay per resident varied greatly from $155,135 in Connecticut to less than half of that in Louisiana ($63,811). New York fared quite well with a cap of 77.13 residents per 100,000 people and total Medicare GME payments of $2 billion. In contrast, Wyoming only receives $1.64 million in total Medicare GME payments and its cap is just 6.64 residents per 100,000 people.

“Ways to address these imbalances include revising Medicare’s GME funding formulas and protecting those states that receive less Medicare GME support in case funding is decreased and making them a priority if it is increased,” Mullan, Chen and Steinmetz wrote. “The GME system badly needs a coordinating body to deliberate and make policy about public investments in graduate medical education."

10. Hawaii

Resident cap per 100,000 people: 13.84

By 2030 Hawaii will need to have increased its primary care physician workforce by 27%, nearly a third of the reason is because of an aging population while 62% is due to population growth and the remainder a result of a larger insured population from the Affordable Care Act.

9. Oregon

Resident cap per 100,000 people: 12.86

Oregon is projected to have one of the largest physician shortages by 2030, according to the Robert Graham Center. Despite such a low cap on resident slots, the state will need an additional 1,174 PCPs by 2030 to maintain the status quo.

8. North Dakota

Resident cap per 100,000 people: 11.52

Despite having such a low cap, North Dakota won’t really face much of a physician shortage — the state will need to increase its PCP workforce by just 5% (27 physicians) by 2030 to maintain the status quo.

7. Mississippi

Resident cap per 100,000 people: 11.25

With 1,475 PCPs currently practicing in Mississippi the state will still need to add another 364 PCPs by 2030 to maintain the current rates of utilization. The projected needed increase of 24% by 2030 is slightly better than the national average. Aging will play a large part of the need for more PCPs as 36% of increase utilization will be from an aging population.

6. Nevada

Resident cap per 100,000 people: 9.10

By 2030 Nevada will need to increase its PCP workforce by 77%, by far the worst projected physician shortage in the country.

5. South Dakota

Resident cap per 100,000 people: 8.84

While the Midwest in general will be facing a much smaller physician shortage than the nation as a whole, South Dakota will fare slightly worse. The state needs to increase its PCP workforce by 27% by 2030.

4. Wyoming

Resident cap per 100,000 people: 6.64

With a current PCP workforce of just 340, Wyoming will need an additional 104 PCPs (an increase of 30%) by 2030 — 26% of the need will be a result of increased aging with 61% from population growth and just 9% from a larger insured population from the ACA.

3. Alaska

Resident cap per 100,000 people: 3.15

Alaska needs to increase its number of PCPs by 40% (that’s an additional 237 PCPs on top of its current 588) by 2030 if it expects to maintain the status quo.

2. Idaho

Resident cap per 100,000 people: 2.24

Idaho only needs an additional 382 PCPs by 2030 to maintain the status quo, but with the resident cap so low, it’s unlikely the state will make it.

1. Montana

Resident cap per 100,000 people: 1.63

The West in general is going to be facing a large physician shortage by 2030, although Montana will far slightly better than the rest of the region. To maintain the status quo, Montana needs to increase its PCP population by 28%.