There’s a math problem facing Indiana, and it has the potential to affect residents’ health care.
There’s a physician shortage, and the problem can’t be fixed just by having more medical school graduates – which Indiana has seen.
The Indiana University School of Medicine’s enrollment has increased by 30 percent since 2007, and Marian University opened a medical school in 2013 that graduates about 150 students each year, said James Buchanan, a Fort Wayne-area resident who spent the last year on Indiana’s Graduate Medical Education Board.
However, Buchanan said, the number of residency programs in Indiana hasn’t expanded at a similar rate. The lack of in-state residencies can lead future physicians to finish training – and eventually practice – elsewhere, he said.
Indiana’s Graduate Medical Education Board was created in the 2015 legislative session to expand medical education by funding new residency program opportunities.
The board first met in January 2016. The initial year involved substantial legwork to get where the board is now: ready to award more than $5 million in grants set aside by the state legislature that should help existing residency programs expand, help determine the feasibility of new programs and help burgeoning programs begin, Buchanan said.
He served on the board as a representative from the Indiana State Medical Association.
Dr. Michael Mirro, chief academic research officer for Parkview Health, said the issue is "incredibly important" to northeast Indiana because hospitals need a workforce to thrive.
IPFW has 85 medical students, he said, and residency programs are the most compelling way to get trained physicians to stay in a community.
Lutheran Health Network CEO Brian Bauer agreed.
"A strong graduate medical education program is a key building block in our mission to provide the high level of health care and access this community needs," he said in a statement. "This is largely driven by recruiting, training and retaining the next generation of physicians."
Data from the Association of American Medical Colleges show how residencies factor into a state’s physician retention rates. In 2014, 47.2 percent of physicians were active in the state where they completed their most recent residency, it reported.
Retention rates were even higher for physicians who completed both their undergraduate medical education and residency in the same state – 66.8 percent. Indiana’s retention rate was 76.9 percent, placing it ninth nationwide, 2014 data show.
Funneling state dollars toward residency programs is important because they rely heavily on federal funding, which is limited, Buchanan said.
The AAMC has advocated for increased federal support to train at least 3,000 more doctors a year by lifting the cap on federally funded residency training positions.
A 2016 study released by the association estimates a national shortfall between 14,900 and 35,600 primary care physicians by 2025. The shortfall for non-primary care specialties is expected to be between 37,400 and 60,300 physicians.
"What we recognize is there’s a shortage of physicians in the state of Indiana, particularly when we talk about primary care and other select specialties," Buchanan said.
Areas of need include family medicine, outpatient community-based internal medicine, outpatient community based pediatrics, OB-GYN, psychiatry, emergency medicine and general surgery, he said.
Medical schools are adding more potential doctors to the pipeline. The AAMC in 2006 recommended that first-year medical school enrollment increase by 30 percent – a goal that likely will be reached in the 2017-18 year.
But now half of medical schools are concerned about incoming students’ ability to find residency positions of their choice, compared to 35 percent in 2012, the association reported, citing a 2015 survey.
John Tan, a second-year family medicine resident with the Fort Wayne Medical Education Program, knows residencies are competitive. U.S. medical graduates compete for slots with graduates from overseas, he said.
Tan, who grew up in Indonesia but moved to Indiana at age 18, began residency interviews at the end of 2014. He credited attending the Indiana School of Medicine and wanting to stay in Indiana with increasing his chances of matching with a program.
Tan said he is enjoying Fort Wayne. His residency enables him to work in Lutheran, Parkview and St. Joseph hospitals, he said.
"We have an awesome opportunity here," he said, adding there is an "incredible number" of beds among the hospitals.
The Fort Wayne Medical Education Program, which has only 30 residents at a time, has seen an increase in applicants and has increased the number of interviews each recruiting season, academic program manager Michelle Harris said.
Most applicants are from Indiana, she said, but the program also receives applications from throughout the country, including the West and East coasts.
The program wants to increase its residency positions to 36 within the next three years, Harris said. A funding application was submitted to the Graduate Medical Education Board for two positions that – if everything falls into place – could be added for the 2017-18 year.
The board has set aside about $2.5 million for expanding residency programs, Buchanan said, explaining recipients will get $45,000 per year per resident. The application deadline was Jan. 10.
Also this year, Buchanan said, the board will accept applications for $75,000 feasibility grants to help hospitals and health centers study whether starting a residency program would be possible. Entities that know such a program is feasible may apply for a $500,000 program development grant to help pay for such costs as hiring staff and buying equipment, he said.
The board has allocated $1 million for the feasibility grants and $2 million for the program development grants, Buchanan said.