Providing health insurance to all Americans is a moot point unless you have doctors available to take care of them. The Affordable Care Act will insure an additional 32 million Americans over the next few years. It is unclear if health care reform "forgot" to fund physician training due to poor planning, kicking the can down the road, or political prowess, given the already huge price tag that the American taxpayer must bear. We may never figure that out. But what we do know is that we are looking at a shortage of more than 90,000 doctors by 2020.

A doctor's training takes more than a decade. All physicians must attain a four year undergraduate degree before attending another four years of medical school. Then, depending on the specialty field of medicine, an additional three to seven of training are required, known as graduate medical education or residency. Residency training is similar to an apprenticeship where the medical school graduate gains the advanced skills necessary for his or her chosen specialty. Residents are selected into hospital-based programs to directly care for patients under the supervision of attending (experienced) physicians.

Medical schools have been able to proactively develop an action plan to increase admissions by 2016. This is because the costs will be covered by the student's tuition (average yearly tuition $28,719 for public schools and $46,734 for private schools).

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Increasing the number of residency training spots, however, requires an act of Congress, both literally and figuratively. These spots are paid by the Centers for Medicare and Medicaid Services, a taxpayer funded entity. CMS pays an average of $100,000 per resident per year and has an annual price tag of $9.5 billion. The last major modification to CMS's graduate medical education budget was 16 years ago. In 1997, Congress passed the Balanced Budget Act that capped funding for residency training and has since prevented meaningful expansion or creation of new programs. Hindsight is 20-20, and we now clearly see that this was based on erroneous predictions that there would be a surplus of doctors.

If Congress, with its 14 percent approval rating, does not act fast, we will have medical school graduates who cannot finish their training. The American Medical Association has described this as a "bottleneck" in the system that prevents the physician workforce from growing to meet the needs of the nation's patients. Without action, this will occur as early as 2015.

Funding needs to be secured for at least 4,000 additional residency spots a year over the next several years to stave off this shortage. This equates to an additional $400 million dollars a year.

The positions need to be strategically created. Doctors are more likely to settle and practice in the same geographic area where they do their residency training. Thus, regional and state-specific needs should be identified. Every state has a vested interest in creating additional positions or new programs.

Furthermore, the projected primary-care and subspecialty needs must be predicted to avoid shortages down the road. Primary-care doctors are instrumental to providing preventive care and managing chronic illness. However, patients will continue to require surgery and need their x-rays interpreted.

With the country's financial health in critical condition, one may ask is this really necessary? The answer is a loud and affirmative yes. Achieving equitable access to quality health care will require an adequate supply of intelligent, hard-working and highly trained physicians.

Funding residency training programs today will reap dividends down the road. But it requires a capital investment. Most physicians pay Uncle Sam six figures in taxes every year. Within a few years, they will have "paid off" what was invested into their training. Doctors are also frequently small-business owners and employ at least three to five employees to run their clinic. Physicians need to contract with several businesses to provide services (e.g. billing, information technology, marketing).

The solution to the doctor shortage is to invest wisely now. What's the point of insuring Americans if we cannot provide them with doctors?

Dr. Nina Radcliff, of Galloway Township, is an anesthesiologist.

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