Doctor Shortage Solution MERC
P R E S E N T E D B Y T R O Y T A U B E N HE I M
MMCGME SERVICES
APRIL 17, 2013
Minnesota is facing a serious doctor shortage
Within 10 years:
 Nationally, we’ll be 90,000 short
 Minnesota will be 2,000 or more short
Minnesota Physicians by Age
 Active MN licensed physicians practicing in
Minnesota = 12,044
 43% are age 56 or older
Age Range
28-35
36-45
46-55
56-65
66-79
Grand Total
Count
815
2,894
3,200
3,470
1,665
12,044
Age 56 plus
5,135
43%
Current Supply and Retirement Demand
 Minnesota Physician Training Programs place 250
Physicians in practice each year.
 An average of 514 active Minnesota physicians per
year will reach age 65 in the next 10 years.
At the same time, we’re expanding access
This is a good thing…
BUT:
 30,000 new patients will be added through
Minnesota’s Exchange in October
 87,000 new patients added from Medicaid
expansion this year
So what can we do?
We are currently advocating for GME funding
restoration.
Our plan:
 Our research shows that training doctors here is the
answer to Minnesota’s doctor shortage.
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Minnesota ranks 13th in active
physicians
Minnesota ranks 10th in active
primary care physicians
Minnesota ranks 12th in # of
GME trainees
53% of trainees are in
primary care
65% stay in Minnesota
US Residency Positions and Applicants
Trainees by Category 2012
1,275 Accredited FTEs
Dental &
Podiatry, 56
Specialty
Fellows, 198
Primary
Care, 512
• Primary Care includes: family
medicine, general internal
medicine and general pediatrics
• Expanded Primary Care
includes: general surgery,
psychiatry and obstetrics
Specialty
Residents,
351
Expanded
Primary
Care, 160
Trainees by Specialty 2012
Primary Care
512
Specialty Residents
Family Medicine
203
Surgical
General Medicine
211
All Other Specialties
General Pediatrics
98
Dental & Podiatric
Expanded Primary
Care
160
General Surgery
69
Psychiatry
55
Obstetrics
36
Specialty Fellows
405
99
252
54
198
Medicine
88
Pediatric
33
All Other
77
MMCGME Retention 2012
72% of graduates remain in region
Foreign-4
1%
Other US
States-81
27%
Greater
MN-45
15%
Regional-34
11%
Metro-138
46%
Of graduates entering
medical practice:
• 61% remained in MN
(25% Greater MN)
• 72% remained in the
region
GME Funding Sources
Source
CMS/HRSA Funding – Allopathic
CMS/HRSA Funding – Dental & Podiatry
VA Funding
Miscellaneous Provider Funding
FTEs OVER CAP
TOTAL
FTES
921.9
33.6
130.1
2.9
187.7
1276.3
GME Funding Sources
Funding Source
Amount
Avg/FTE
FEDERAL
CMS,HRSA & VAMC
$97,500,000
$86,970
STATE
MERC to hospitals
(70% from GME)
$29,105,000
$25,963
Funding All Sources per FTE
2010
$112,933
2012
$100,055
Funding Cuts and Threats
MERC 50% cut
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Total Reduction 2011: - $32,083,000
2013 Legislation?
Federal GME Cuts
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2% Sequestration April 2013 = -$1,950,000
IME 10% = -$9,750,000
Or more?
CHGME cuts are a constant threat.
President Obama FY 2014 Budget
 $401 billion in cuts over ten years to health care
 $307 billion over ten years from Medicare providers
 Medicare indirect medical education (IME) $11 billion
 $68 billion in Medicare structural reforms
 $19 billion in Medicaid cuts
 Medicare bad debt payments by $25.5 billion
 rebasing Medicaid disproportionate share hospital (DSH)
payments $3.6 billion, over ten years.
GME Costs
Cost Study September 2012
Stipend and benefits cost per resident $60,978
 Administrative costs per resident
$32,269
 Total direct costs
$93,247
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Indirect Costs
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Hospital Specific and Non-Validated
MMCGME Hospitals Average Total Cost
$149,291
Our talking points:
This is a workforce development issue
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We want tomorrow’s doctors to stay in Minnesota.
Demand will continue to grow for all kinds of doctors – from
family physicians to cardiologists.
Best way to keep doctors in Minnesota: training
doctors in Minnesota
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65% of physicians trained through Minnesota Graduate
Medical Education remain here to practice medicine.
Our talking points:
Access to quality health care
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Primary quality of life issue for every Minnesota community
Critical to recruiting the best and the brightest in all
professions.
Training fewer Minnesota doctors will impact
Greater Minnesota more
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Primary care far more than specialty care.
Our talking points:
Stable funding is needed for GME to be successful.
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Hospitals make a 3 to 7 year commitment when a physician
starts their residency.
A great GME program supports both primary care
and the specialists who are needed to address the
needs of a changing population.