Florida hospitals have seen a 29 percent increase in the number of residency slots since 2013, but the state still faces physician workforce challenges, a report on graduate medical education released Wednesday shows.
The report, “Training Tomorrow's Doctors: Graduate Medical Education in Florida 2017,” shows that Collier, Lee and Sarasota counties face a severe shortage of primary-care physicians. Moreover, despite the state adding 1,113 residency slots in the last four years, the report shows that the number of residencies in neurology, thoracic surgery, nephrology and ophthalmology has declined.
Steve Sonenreich, president and CEO of Mount Sinai Medical Center, said he hopes lawmakers will consider the findings as they meet in January to begin working on a state budget for the upcoming year. He would like the Legislature to provide Southwest Florida hospitals a $100,000 bonus for each graduate medical education primary-care residency created and to provide another $5 million to entice hospitals to retain graduate medical education slots in neurology, thoracic surgery, nephrology and ophthalmology.
“What we are trying to do is to bring to the forefront the population continues to grow and the population continues to age, and access to physicians --- everybody has heard a story of friends, neighbors --- the difficulty in gaining access to physicians,” he told The News Service of Florida. “Additional funding to support graduate medical education is in our institutions is something very important.”
"The number of residencies that we've had in this state hasn't kept pace with the growth of the population,” Sonereich said. “So if we're going to succeed in curing this shortage over the next several years, we need to continue to expand the number of residency positions, and the funding for those positions."
The request is in addition to already-existing graduate medical education initiatives. In 2013, lawmakers directed $80 million in recurring funding and directed it toward the Statewide Medicaid Residency Program. The state had an estimated 3,896 residency slots before the program was created. Since then, Florida has funded an additional 1,113 slots for a total of 5,009. Lawmakers in 2017 agreed to direct an additional $17 million to the program to keep pace with the growing demand.
The 2017 report was published by the Safety Net Hospital Alliance of Florida in partnership with the Teaching Hospital Council of Florida, which Sonenreich chairs. It builds off the findings of a 2015 analysis conducted on behalf of the groups by IHS Markit, formerly IHS Global, which found Florida faced a shortage of nearly 7,000 physicians through 2025.
In response to the 2015 report, lawmakers created the Graduate Medical Education Startup Bonus and Retention Program where hospitals are paid a one-time $100,000 startup bonus for every residency slot created in a shortage specialty. This year, the program resulted in the creation of 313 new residency positions in many of the 20 physician specialties where deficits exist.
“So currently we have a bonus program that the state is very proud of and has been very successful in this last year,” said Lindy Kennedy, Executive Vice President of the Safety Net Hospital Alliance of Florida. The GME bonus program supported over 300 new slots created in these physician specialties and shortages and we're recommending essentially that we double that bonus for residencies that are created in each of these four declining specialties.”
Sonenreich said his group's goal is to ensure that tax dollars are directed to support residency slots in areas that will help the state the most.
“What we're really talking about here is trying to formulate good public policy, and good public policy is to identify where our community, our state, has a deficiency and then try to encourage funding of those residencies so they are available for people to take advantage of,” he said.
He says these residency slots are important because 80 percent of physicians that complete a residency stay in the state or the community where they completed that residency training program. And because the entire nation is facing physician shortages, hospitals can’t necessarily draw doctors to Florida from other states.
In addition to requesting money to train future physicians, the Safety Net Hospital Alliance of Florida and the Teaching Hospital Council of Florida also are requesting that the Legislature appropriate $50 million to help offset the costs of charity care provided by teaching hospitals.
The Safety Net Hospital Alliance of Florida's 14 member hospitals provided nearly $580 million in charity care but received about $209 million in supplemental payments from the Low Income Pool program, according to Kennedy.