Medicare GME caps may be hurting geriatrician supply

Physicians worry about access to specialists for baby boomers.

By Markian Hawryluk, AMNews staff. May 12, 2003.

Washington -- Charles Cefalu, MD, was like many other residents in geriatrics. With no geriatric program in his home state of Louisiana, he went to study at Wake Forest University in North Carolina in 1990 and taught at Georgetown University in Washington, D.C., for five years. It was for personal, not professional, reasons that he finally returned to New Orleans to practice and teach.

"I'm another example of a physician who goes out of state to train and then, for a while at least, doesn't come back to his home state," Dr. Cefalu said. While family brought him back, he returned with a primary goal of developing the state's first geriatric medicine fellowship.

That program is now under way at the Louisiana State University School of Medicine, but Dr. Cefalu said many other states are not as lucky. Congressionally imposed caps on the number of residents for which Medicare will provide graduate medical education funding to hospitals is, in part, limiting the number of geriatricians trained in the United States, he and others say.

Dr. Cefalu fears there won't be enough geriatricians to meet demand as the baby boomers age. "The supply is woefully low and not even close to meeting projected need," he said.

Congress imposed the caps as part of the Balanced Budget Act of 1997, which effectively froze at 1996 levels the number of residents for which a hospital could draw GME payments. Lawmakers later softened the limit in rural areas to 130% of the 1996 levels and allowed rural hospitals to start residency programs for new specialties, even if that would exceed their caps. But for urban teaching hospitals, adding a resident in geriatrics means eliminating a residency slot for another specialty.