The Executive Suite: Medicare-supported GME residency positions look to grow the physician workforce and expand health care access

The Centers for Medicare & Medicaid Services (CMS) published its official list of teaching hospitals that were rewarded new Medicare-supported graduate medical education (GME) positions, which were created under Section 126 of the Consolidated Appropriations Act, 2021 (CAA, 2021). The new residency positions—of which there are 200—are intended to contribute to the growth of the physician workforce, allowing for easier access to care for patients across the United States. Approximately 70% of the newly awarded positions will be in primary care and psychiatry residency programs, according to the CMS.

“These new residency positions will have a tangible, positive impact on a diverse mix of communities across the nation, including traditionally underserved areas,” David J. Skorton, MD, president and CEO of the American Association of Medical Colleges (AAMC) said in an organizational release. “Medical school enrollment has continued to grow, but a commensurate increase in residency positions is necessary to help ensure that there are enough opportunities for medical school graduates to complete their training and practice independently.”

According to projections published by the AAMC in March 2024, the U.S. will face a physician shortage of up to 86,000 physicians by 2036. Specific to primary care, the AAMC projects a shortage of 20,200 to 40,400 physicians by 2036. The projection has most of the specialties included under primary care in shortage by 2036, with the exception of general pediatrics, which is expected to be near equilibrium. At the time of the report’s release, Skorton cautioned that, “Without funding beyond current levels, the [GME] growth trajectories hypothesized in this year’s report will not materialize.”

According to the new AAMC release, Congress voted to expand Medicare support for GME—the only increases since the Balanced Budget Act of 1997—in 2021 and 2023 year-end spending packages—(CAA, 2021 and the Consolidated Appropriations Act, 2023 (CAA, 2023).

CMS first announced the distribution of new Medicare-supported residency position awards in 2022 and has distributed new positions each year since. In what is officially the third distribution of positions provided by the CAA, 2021, 109 teaching hospitals across 33 states received slots, which go into effect on July 1, 2025. To date, CMS has distributed half of the 1,200 positions made available under the two laws.

“Teaching health systems and hospitals that choose to train medical residents incur real and significant mission-related costs, beyond those typically associated with providing care,” explained Jonathan Jaffery, MD, chief health care officer of AAMC. “These residency positions are crucial to helping America’s academic health systems and other teaching hospitals invest in more physician training, increase access to care and better serve patients nationwide.”

In their statement, the AAMC applauded CMS’s efforts to address the high-priority workforce shortage, while also urging Congress to build on the progress made through the CAA, 2021 and 2023 by passing the Resident Physician Shortage Reduction Act of 2023 (S. 1302/H.R. 2389). The legislation would gradually increase the number of Medicare-supported GME positions, which would thereby enable progress toward a sustainable physician workforce—one to meet the nation’s patient care needs.

“The AAMC, our members, our partners in the GME Advocacy Coalition and Congressional champions have worked tirelessly on increasing the number of Medicare-supported GME positions to help address the physician shortage and improve health for patients nationwide,” Danielle Turnipseed, JD, MHSA, MPP, chief public policy officer of AAMC, said in the organization’s release. “Both the CAA 2021 and 2023 were important initial steps toward helping to alleviate the national physician shortage and chip away at the cap on slots that has been in effect for almost 25 years. Additional Medicare-supported GME slots are needed to ensure we have qualified physicians to meet the growing and ever-changing health care needs of patients everywhere.”