Budget lacking funds for medical residencies, despite statewide doctor shortage

Health care advocates are becoming increasingly concerned after learning that the budget deal that Gov. Doug Ducey struck with Republican legislative leaders does not contain money for graduate medical education funding, commonly referred to as GME.

GME refers to funds that are distributed by the state to local hospitals and clinics to help them train medical students for things like residencies, internships and fellowships.

Currently, Arizona is among the worst in the nation for its ratio of primary care physicians to residents, according to a study by the University of Arizona.

“Arizona is a net exporter of doctors, which means we ship out more than we retain,” Anne Newland M.D., CEO and doctor with Northern Country HealthCare said to the Arizona Mirror.

The state has not provided funding to the Graduate Medical Education Program for nearly 10 years, which advocates say is contributing to the shortage. The program provides funds to hospitals that provide education and training, such as residencies or internships.

To Newland and other healthcare professionals, increasing GME funding, specifically for rural communities like the ones she helps serve, would entice new doctors to stay in the state, especially since in many cases, the place a person does their residency ends up being where they stay, Newland said.

The Health Resources and Services Administration estimates that Arizona needs an additional 563 primary care doctors in order to properly address the physician shortage in the state – a shortage that will only worsen, as nearly one-quarter of physicians currently in Arizona plan to retire in the next five years, according to the UofA study.

An additional 1,941 doctors are expected to be needed by 2030 to be able to adequately care for Arizona’s growing population, according to workforce projections by the Robert Graham Center.

“I think this budget priority has received overwhelming support,” Sen. Heather Carter, R-Cave Creek, who has been working all session to try and increase GME funding. “I will continue advocating to have it included in this year’s budget.”

Carter is the sponsor of two bills that aim to address GME by providing new and additional funds to the GME program and by creating a study committee to look into the doctor shortage problem.

Both her bills won Senate approval but have yet to have a final vote in the house.

Senate Bill 1354 would appropriate $50 million from the state general fund to finance several initiatives, including additional funds for GME, to combat what advocates are calling a crisis. The Senate approved the bill on a 28-2 vote with only Sens. Eddie Farnsworth, R-Mesa, and David Farnsworth, R-Mesa, voting no.

Senate Bill 1524 would direct the Arizona Board of Regents to create a working group and pilot program to address the state’s nursing shortage. The bill won unanimous approval in the Senate.

“We believe Gov. Doug Ducey and legislative leaders have missed an opportunity to combat the physician shortage by funding programs like Graduate Medical Education,” Arizona Hospital and Healthcare Association President and CEO Ann Marie Alameddin said.

A study commissioned by AzHHA found that Carter’s bill that would add funding to the GME program could bring in up to $20 million in new state taxes over the next 10 years.

Carter said she plans to continue to fight for GME funds to be included in the state budget.

Carter is also currently involved in a battle with GOP leadership over a bill aimed at increasing the rights of victims of child sexual abuse, which could block a budget vote.

The problem

Rural communities in Arizona seem to be feeling the effect of the shortage more than other areas of the state.

Yuma and Santa Cruz counties have 100 percent of their populations living in a Health Professional Shortage Area (HPSA), according to research by the University of Arizona’s Rural Health center.

Cochise County isn’t far behind, with 98 percent living within a designated HPSA area.

HPSAs are defined as places that have a shortage of primary care, dental care or mental health providers when compared to the population needs.

Newland said it has become harder and harder to recruit doctors to rural communities, especially since many are likely not receiving the proper training.

Many doctors are used to having a specialist down the hall who they can ask questions or refer a patient to, but in some areas of the state, a specialist could be hours away.

“As a doc living out there, I had patients coming to my home when they needed medical help in the middle of the night,” Newland said of her time as a doctor on the Navajo reservation.

This is part of what makes GME funding critical to Newland. By having more funds to entice more doctors to rural communities, it can help train them on the challenges those communities face and how to properly treat them.