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AACU Sentinel
The Newsletter of the American Association
of Clinical Urologists (AACU)
Promoting and Preserving Professional
Autonomy and Financial Viability since 1968
AACU OFFICERS
President
Arthur E. Tarantino, MD
Hartford, CT
President-Elect
Mark S. Austenfeld, MD
Kansas City, MO
State of the Fed
By: Joe Arite, AACU Associate Director of
Government Affairs
Secretary/Treasurer
Charles A. McWilliams, MD
Oklahoma City, OK
Workforce Shortage Spells Out Access to
Care Crisis
The size of the physician workforce has long
been an issue in the United States. It is undisputed that well-educated and trained physicians are needed to ensure access to care for
millions of Americans. So why has the physician workforce been neglected for the last decade?
In the 1980s and 1990s, workforce analysts and public policymakers
predicted the United States would experience a substantial excess of
physicians by the beginning of the 21st century. The Balanced Budget
Act of 1997 capped the number of resident physicians each teaching
hospital could claim for reimbursement under Medicare. Medicare
does not generally reimburse teaching hospitals for training residents
beyond the capped number of Graduate Medical Education (GME)
slots.
In 2007, the Council on Graduate Medical Education recommended
removing the current cap on physician residency slots and increasing the number of funded GME slots by 15% to address physician
shortages. Although medical schools are increasing their class sizes,
Medicare-funded GME residency positions have not increased.
Immediate Past President
B. Thomas Brown, MD, MBA
Daytona Beach, FL
Historian
Jeffrey M. Frankel, MD
Seattle, WA
The AACU Sentinel Staff
Editor: Charles A. McWilliams, MD
Associate Director: Joe Arite
Managing Editor: Ruth A. Gottmann, MBA
All specialties are not the same. Over the last two decades, urologic
residency positions have grown despite a Medicare / Medicaid cap on
residency education funding. Institutions have used physician clinical
revenue and hospital revenue to support the growth of the urology
shortage of both academic and practicing urologists. Currently, academic urology residency training programs are using clinical revenue
to support unfunded urology residency positions, added expenses of
the mandated educational program requirements, surgical simulation
labs, and added staff to cover shortages secondary to duty hour restrictions. This is not sustainable.
is evaluating the funding of graduate medical education and is considering a decrease in support for specialty training while increasing
It is widely recognized that the current method of supporting gradu-
urology over the past several years. Continued on page 4