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Bills add residency slots for FL

By Christine Jordan Sexton
12/3/2009 © Health News Florida

Florida’s lagging physician workforce could get a shot in the arm under versions of the health care reform bill being debated in Washington. 

Both the House and Senate bills allow Florida hospitals and medical schools for the first time in 12 years to increase the number of residency slots that are paid for in part with Medicare dollars. 

The bills would do so by shifting unused slots in other states to growing states that have a need for more physicians. Adding residency slots should produce a larger medical workforce long-term, since studies indicate more than half of doctors begin private practice in the same area where they were residents.

Moving slots from one state to another “is a huge shift in policy,” Rep. Kathy Castor, D-Tampa, told Health News Florida. Castor has been influential on the graduate medical education issue.

The bills don’t include specifics, but Castor said she thinks Florida could gain as many as 200 residency slots. 

A 2009 Association of American Medical Colleges survey indicates Florida ranks 43rd when it comes to the number of resident physicians per 100,000 population. There were just 3,285 residents per 100,000 population. 

Only seven states have a lower rate of resident physicians: Alaska, Idaho, Mississippi, Montana, Nevada, South Dakota and Wyoming. 

“Florida is in dire straits when it comes to training new doctors,” Castor said. 

Sen. Charles E. Schumer, D-N.Y., has filed an amendment to the Senate bill that would provide $2 billion in additional funding over 10 years to create 2,000 residency slots nationwide, including Florida, according to a Washington Post report. 

To be sure, neither bill will meet the need. The 2009 AAMC survey indicates that the state would need to add close to 3,000 new medical slots to reach the national average. 

Graduate medical education, the hands-on training that follows medical school, allows young physicians to care for patients under the supervision of faculty physicians. Residency lasts three to six years, depending on specialty, and afterward doctors begin practicing independently. 

Residents often work in the large teaching facilities that treat a large number of indigent and under-insured patients. According to recent studies based on census data, between 20 and 25 percent of Floridians under age 65 had no insurance in 2008.

It costs about $200,000 a year to train a resident in Florida, said Tony Carvalho, president of an association of teaching hospitals in the state. Medicare subsidizes about $80,000 a year per slot and Medicaid offers $29,000. But Medicare pays only for slots created before 1997, when Congress capped the number of subsidies because of budget concerns. 

Since then, Florida has added four new colleges of medicine -- at Florida State University, University of Central Florida, Florida International University and Lake Erie College of Osteopathic Medicine in Bradenton – with 1,500 medical students. During that time, the number of residency positions went up by 500, which means most of the new grads will have to leave the state for residency.

Some members of the Board of Governors of the state university system said later the state would have been better off funding residency positions instead of new medical schools. 

Florida’s aging physician workforce currently meets the national average overall, but not among those who provide direct patient care. In that group, Florida’s average is 252.1 per 100,000, slightly lower than the national rate of 254.5.

The state also lags in the number of primary care physicians, a key indicator of the quality and effectiveness of a health care system. The median rate of primary care physicians per 100,000 is 89.9 nationally, but just 85.6 in Florida. 

And it could get worse. A state Department of Health survey of 21,610 Florida allopathic (M.D.) and osteopathic (D.O.) physicians, found that 10 percent of those in primary care are over age 67. Thirteen percent of doctors who responded to the survey said they would retire or reduce the scope of their practice within the next five years. 

“The sky is not falling today but we are facing a crisis down the road,” Carvalho said. “One day we are going to wake up as a state and find one of our problems is going to be an insufficient number of physicians.” 

--Christine Jordan Sexton, an independent journalist, is co-founder of