More Residency Slots Could Mitigate FL's Projected Physician Shortage

Increasing the number of residency slots may be the key to preventing the substantial physician shortage Florida is projected to experience in the upcoming years.

A report prepared for the Safety Net Hospital Alliance of Florida revealed that the state could face an estimated shortage of 18,000 physicians by 2035.

The main driver of this projected physician shortage is the aging population of both Florida residents and doctors, according to Justin Senior, chief executive officer of Safety Net Hospital Alliance of Florida.

“The population is growing, but the population segments that are growing the fastest are the 65 to 74-year-old segment and the 75 and up segment,” Senior told RevCycleIntelligence in a recent interview. “And that population is the one that needs the most in terms of nursing services and physician services.”

In addition to an aging community, Florida’s physician population is getting older. Senior anticipates that tens of thousands of doctors will retire in the next five to ten years, becoming consumers of physician services rather than suppliers.

The projected shortage is based on pre-pandemic data, so the impact of the pandemic on the physician workforce shortage is still unknown, Senior indicated. However, the pandemic may have accelerated the pace of retirements in Florida, suggesting that the actual shortage could potentially be more severe.

An aging population requiring more care coupled with doctors reaching retirement age puts hospitals in a precarious situation. Florida must go beyond simply replacing the retiring physicians to keep up with increased patient demand, Senior explained.

Prioritizing residency programs can help get hospitals on track to produce more physicians.

After receiving undergraduate degrees and completing four years of medical school, physicians must then complete a residency program, which can take several years. Hospitals host residents and teach them how to become physicians in their specialty and subspecialty.

Physicians who would be joining the workforce in 2035 are currently in college, highlighting the importance of ensuring there are enough residency slots for them when they graduate.

Where physicians do their residency is the primary indicator of where they’re going to ultimately practice medicine, Senior said.

“Historically, Florida has not had as many residency slots as other states,” Senior pointed out. “So, people graduate from a medical school in Florida, but then they do their residency potentially in another place, and it becomes very likely that that other state is where they’re going to practice medicine.”

Hosting residents can present a financial barrier for some hospitals, considering hospitals must increase their payroll to compensate residents. In addition, hospital staff must teach and train the residents, which may slow down the number of procedures the facility performs.

Florida developed a program to help hospitals offset the cost of hosting residents in hopes of increasing the number of graduate medical education programs.

“Since Florida did that about six or seven years ago, the number of residents in the state of Florida has doubled,” Senior shared. “And the number of hospitals in the state of Florida that are hosting residents has actually nearly tripled. So, it’s been a very effective program over the course of the last six or seven years. Our recommendation to policymakers would be to expand that program.”

Hospitals became more willing to host residents when they were assured the associated costs would be offset. The 14 public hospitals, teaching hospitals, and children’s hospitals included in the Safety Net Hospital Alliance of Florida host around half of all residents in the state of Florida, Senior noted.

In addition to expanding the nation’s residency program, federal policymakers should increase Medicare graduate medical education funding.

“Historically, that program has been centered in the Northeast and has centered residents in the Northeast and in the Midwest and that needs to change,” Senior asserted. “The federal government should increase the amount of funding that they have for Medicare.”

“And the formulas should be changed so that the money follows where the actual population in the United States is moving, which is to the Southeast and to the Southwest—to the Sun Belt, essentially.”

State governments, which operate the Medicaid and CHIP programs, can also help encourage hospitals to train physicians by offsetting costs.

If policymakers do not take steps to address the impending physician shortages, hospitals will likely see financial repercussions.

“Unless that supply and demand imbalance is addressed, you’re going to see increased costs and increased prices, and those increased prices start to affect access,” Senior explained. “It makes hospital services more expensive. It makes going to a primary care physician more expensive for the public.”

The cost of physician services will likely rise at hospitals and private physician’s offices for privately and publicly insured individuals, Senior noted.

While hospitals may not experience financial consequences until the future, addressing the issues now can help facilities avoid the expected shortages.

Rising costs that lead to care access barriers can create a public health issue, although Senior hopes it will not come to that.

“We have forward-thinking policymakers here in the state of Florida who can help with this. We’ve had good conversations with various policymakers in the House, the Senate, and in the governor’s office,” Senior concluded.

“Our hope is that we can start to jump on this over the course of this year and next year to make sure that Florida can increase the number of graduate medical education slots that there are and increase the number of physicians that are practicing in the state of Florida and really match that, not just the big number, but have the right types of specialists and subspecialists that the state is going to need.”