Save GME and Alleviate the Physician Shortage!

I’m sure that most have heard of the massive physician shortage this country faces, especially the shortage of primary care physicians. Under the sequestration, Congress has cut funding to Medicare by 2%, and Graduate Medical Education (GME) is part of Medicare. This is unfortunate, but just about everything funded by the government has taken a cut. Now more importantly, President Obama's 2014 budget includes an $11 billion cut to GME over the next decade! Pediatric residencies are funded separately, and Obama's budget includes a reduction from $265 million to $88 million in 2014! GME has already been cut 2% due to the sequestration, which equates to about 2000 residency positions out of the current 100,000 funded residency slots (a cap set by Congress in 1997). GME provides medical school graduates, or residents, the opportunity to complete the required years of clinical training necessary to obtain a medical license and become a practicing physician.

This year 528 U.S. MD medical graduates did not match into a residency, which is more than double the number from last year. Including DO (osteopathic) and foreign medical graduates, there were about 1700 that did not match into a residency. With a current physician shortage of about 16,000 and about 25 million Americans entering the health care system in the next few years under the Affordable Care Act, cuts to federal funding for residency programs will only worsen physician shortages. Workforce experts predict a shortage of 62,900 physicians by as soon as 2015.

Congress can help remedy this problem by doing two things: (1) retaining federal funding for GME, and (2) raising or eliminating the annual cap on the number of residents each year (currently 100,000). We need these changes in order to protect our most vulnerable Americans. I need you to submit letters to your Senators and Representatives to tell them to do these things. You can find your Senators here and your Representative here. You can basically copy much of this post for use in your letter. Thanks for your help!

High Quality Research Act

Earlier this year, Lamar Smith, the new chair of the House of Representatives Committee on Science, Space, and Technology, drafted a bill that would require that the National Science Foundation (NSF) director certify that projects funded by the NSF are groundbreaking and in the interests of national health and welfare. Additionally, it would also set in motion a process to determine whether the same criteria should be adopted by every other federal science agency. This could potentially politicize decisions made by the NSF. The bill is called the High Quality Research Act, and it has not yet been formally introduced in Congress.

Specifically, the draft would require the NSF director to post on the NSF website, prior to any award, a declaration that certifies the research is:

1) “… in the interests of the United States to advance the national health, prosperity, or welfare, and to secure the national defense by promoting the progress of science;

2) “… the finest quality, is groundbreaking, and answers questions or solves problems that are of utmost importance to society at large; and

3) “… not duplicative of other research projects being funded by the Foundation or other Federal science agencies.”

At face value to a lay audience, this may not seem like such a bad thing; after all, don’t we want our tax dollars to fund innovative research that has the potential to cure diseases? However, it is concerning that bill could potentially undermine the peer review process, which has always been at the crux of scientific research. The best feedback and criticism comes from other researchers in the same field, and this needs to continue. However, this is probably the worst-case scenario. In reality, it seems to me that this bill would not have the power to replace the peer review process, and it says nothing about doing so.

I can understand the motivation for writing such a bill. The government is appropriating less money for research, especially after the sequestration cuts, so with its limited resources it should fund projects that are of greatest interest to the American people. However, I really do not see this bill having much effect because the NSF and our country’s scientists use these promises (i.e. their work is groundbreaking and of interest to the American people) to justify their grant recipients and research, respectively. Nevertheless, it is important to be mindful that this bill could potentially undermine the peer review process.

Gun Policy Ideas

I have previously discussed the gun crisis we have in this country. So how are we going to deal with it? First, Senator Manchin announced on April 29 that he would reintroduce a bill requiring universal background checks. This is something we all need to get behind, as it is sound policy for our health and is supported by about 90% of Americans. Under current federal law, people who buy weapons from federally-licensed gun dealers have to undergo a background check. The name is submitted to the National Instant Criminal Background Check System (NICS), which is a computerized background check system designed to respond within 30 seconds on most inquiries. Private transactions are not covered by federal law, so no background checks are required.

Second, the NICS database needs to be strengthened because 28 states do not report inpatients with mental illness, and 17 have reported fewer than 10 mental health records since database’s creation. Furthermore, the U.S. General Accounting Office(GAO) estimates that NICS’s mental illness data falls short by 2 million individuals. New York made a step in the righ direction when it recently passed the New YorkSecure Ammunition and Firearms Act of 2013, requiring mental health professionals (psychiatrists, psychologists, social workers, nurses, etc.) to report patients deemed likely to seriously harm themselves or others, check the gun license database, suspend the individual’s gun license, and send a police officer to remove the firearm. I am curious to see the gun violence data in New York following this law.

Third, we need to get rid of high capacity weapons. The problem is that there are so many of them in circulation, and guns are durable goods and will not dissolve or expire. A solution might be to offer payouts for returning your guns, but obviously this will require government funding.

Fourth, we need to do more research on smart gun technology. A smart gun is a gun that will only fire in the hands of its lawful owner and can use technologies such as fingerprint recognition, magnetic rings, and other. Eventually it might be possible to require gun companies to include this technology in their products. New Jersey jumped on this and passed the Childproof Handgun Bill in 2002 that requires new handguns to contain a mechanism that only allows their owners to use them.

Fifth, we need to strengthen policies concerning gun shows, because approximately 40%of guns sales occur at gun shows. A possible option is requiring background checks before anyone enters a gun show. This would prevent the large number of gun sales that occur without background checks at gun shows.

These ideas for policy change are not going to fix all our gun problems, but they will make steps in the right direction.

Support Biomedical Research!

Time to hold on for dear life: we have reached the fiscal cliff! Being a physician scientist in training, one of my biggest concerns is the 8.4% cut to National Institutes of Health (NIH) funding of biomedical research. Every single time a doctor evaluates a patient or prescribes a therapy for a serious illness, federally funded biomedical research plays a key role in the process. We need to continue to make progress in learning about and treating incurable diseases, and this cut in NIH funding severely undermines such progress. Currently, about 90% of research proposals made by scientists and physicians are rejected for funding by the NIH due to resource limitations. This is an unhealthy rate and will only worsen if the NIH budget is further reduced.

I’m probably preaching to the choir; I would hope that everyone knows how detrimental this is for research. However, what people may not realize is what it can do for young people in training to become scientists or physician scientists. We need to be concerned with how this funding drop will affect our future, not just the present research. Looking down the road, this low level of funding and insanely competitive grant applications will inhibit young people from entering careers in biomedical research.

Another possible ramification of decreased biomedical research funding is that it accidental discoveries may become less likely. Some of our greatest advancements have been made by accident, namely Alexander Fleming’s discovery of penicillin. Only grants that are extremely well thought out and have very clear, logical hypotheses get funded. This leaves little/no room for riskier experiments where there is no clear hypothesis.

So what do we do about it? Well we cannot just sit back and wait for it to happen. You can write letters to your Senators and Representatives. You can write letters to the editor of newspapers or magazines. We must let our voice be heard so that America’s future biomedical research is not jeopardized.