New IOM report includes recommendations to overhaul current graduate medical education system

The Institute of Medicine (IOM) released a report, Graduate Medical Education That Meets the Nation's Health Needs, which encompasses recommendations to overhaul the current graduate medical education (GME) system. The American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) commend the two-year effort it took to develop this report and are pleased that the IOM committee supported continued Medicare funding of GME. We are, however, disappointed that the IOM failed to adequately address the looming shortage of neurosurgeons. In addition, we are very concerned that the recommendations calling for cuts to GME financing and other changes may jeopardize neurosurgical residency training programs.

Experts agree that the country faces a severe physician manpower shortage. This shortage will become even more acute as health insurance coverage is expanded to an additional 30 million Americans and the baby boomers continue to reach retirement age. Overall, according to the Association of American Medical Colleges, the shortage will approximate 130,600 physicians by the year 2025 — 64,800 specialty physicians and 65,800 primary care physicians.

"In the U.S., there are about 3,800 practicing board-certified neurosurgeons serving a population of more than 318 million people. As the population ages and more of our citizens face debilitating and life-threatening neurological problems, such as stroke, degenerative spine disease, Parkinson's disease and trauma to the brain and spine, this supply-demand mismatch will become even more acute," said AANS president, Robert E. Harbaugh, MD.

This shortage has a number of consequences that may limit patient access to neurosurgical care, including:

• Demand for neurosurgical services will increase by 20 percent over the next decade, far outpacing demand for adult primary care services. As a result, patients are already experiencing significant wait times for neurosurgical care, and this is likely to get worse.
• The concentration of neurosurgeons in metropolitan areas results in 25 percent of the U.S. population living in a county without a neurosurgeon.
• Neurosurgical coverage is essential for effective trauma care, and one-quarter of all Americans do not live within 60 minutes of a Level I adult trauma center. Even more do not have a Level I or II pediatric trauma center within their reach.
• Neurosurgeons are getting older, with 44 percent of the current neurosurgical workforce over the age of 55. In addition, the time required to become a board-certified neurosurgeon is much longer than for primary care and many other specialties — as much as 18 years from the start of medical school to board certification — so replenishing the neurosurgical workforce is no easy task.

CNS president, Daniel K. Resnick, MD, noted, "An essential solution for increasing physician numbers involves not only increasing medical-student class size and the number of medical schools, but also increasing the number of funded residency positions, which Congress can do by lifting the cap on the number of federally supported residency training positions." Dr. Resnick added, "Unfortunately, the IOM has gone in the opposite direction by recommending cuts in GME funding, which will likely exacerbate the predicted physician shortage."

An appropriate supply of well‐educated and trained physicians is essential to ensure access to quality healthcare services for all Americans. Organized neurosurgery is committed to ensuring that our patients have access to high-quality neurosurgical care, and we stand ready to help develop policies to avert the impending physician workforce crisis.