Arizona’s universities have put a lot of money into opening and expanding medical schools in our state as we face an ongoing physician shortage.
But Brittney Kaufmann says it’s all for naught unless we get more government funding for residencies that train new physicians in real hospital and health care settings.
Kaufmann is CEO of the Health System Alliance of Arizona, which represents the larger hospitals and health systems in the Valley. She came into our studios recently to talk more about a recent op-ed she published in the Arizona Republic outlining the problem, beginning with just how bad the physician shortage in our state is.
Interview highlights
BRITTNEY KAUFMANN: The physician shortage in Arizona is pretty severe. It's not a near and looming thing. It's a now thing. You've probably experienced it. Many of your listeners, I'm sure have already seen whether it be a delay or it's more difficult to get in with your primary care physician. Maybe it's more difficult to find a specialist or long wait times to get in to see a specialist. And unfortunately, maybe even longer wait times in emergency rooms. Arizona has just grown significantly and our health care workforce and particularly physicians has just not kept up. So quite simply in economic terms, the demand does not equal the supply.
When it comes to like primary care doctors, general practice, family doctors — what does that look like?
KAUFMANN: Definitely the primary care physician short is, is by far the largest. Ee're experiencing them ion all these different subspecialties, but primary care is exponentially more prominent in the state. So just recently, the Arizona Board of Regents said we need 667 or more primary care physicians to just meet today's demand. That's not even the future demand. We would need over 2,000, we think to meet the demand by 2030.
So 44% of Arizona, they live in communities with physician shortages. And we're not just talking rural anymore or those underserved communities, they fill it most acutely, but we're also experiencing it just throughout the whole entire state.
There have been multiple big investments in medical schools. We have several here already. Universities now are starting or expanding medical school programs. But this is not going to necessarily solve the problem. Tell us why.
KAUFMANN: Correct. Really, The problem we have is a bottleneck. We don't have the necessary physician training. So we have schools and opening new schools is great, and we are supportive of that. But we also need, with that the training that comes after they graduate. So they go to medical school and then really primarily hospitals do the physician training — that hands-on training those residencies that are required to practice in the United States.
Explain how this works. Who funds that?
KAUFMANN: Most of the funding, the vast majority of the funding, comes from the federal government for the Centers for Medicare and Medicaid Services. With that though we have not seen in significant expansion since the late '90s. So really, in 25 years, there has not been expansion of that funding. What also happened with the funding, it was in essence, is frozen in time in 1997 when they stopped the funding. They still fund, but just at those levels based on what hospitals were training at the time, how many physicians they were training at the time. And since then, our demographics across the country have drastically shifted. And especially in Arizona over the last 25 years, we have grown exponentially. We have also not only our population size, but the number of the aging in our state is really growing exponentially. And then you add that longer life expectancies. Unfortunately, we've had an increase in chronic diseases, behavioral health conditions. It really has just exacerbated the problem.
So, how underfunded are residency programs here in our state?
KAUFMANN: That is hard to say, but I would say hundreds of millions. It is time intensive and cost intensive to train these physicians. And the federal government knows that and they've done it because they're training physicians for the nation, right? They go on and train in a hospital setting. It's not guaranteed that they will stay there. There's a high chance. Ee know that they are the vast majority of those residents where they train, they stay in practice. But it's not a guarantee. We would imagine in the state given, we could use hundreds of millions of dollars more just to even make a dent in this issue.
Is this something then that is being brought to the the government's attention nationally? Are you not the only voice in a chorus of voices saying we need to do this?
KAUFMANN: No, definitely we are not the only one. This has been brought up. I think there's a bill that's been introduced in Congress — I'm going to say around 10 times. I mean, people know, but that action just hasn't been taken. So people are aware, I just, I don't know if there's urgency yet, but we don't want the urgency to be where people can't see doctors when they, when health care is not accessible. Because people could experience devastating consequences and it could be devastating for the state. And we don't want to get to that point. We want to make sure that we address this issue now. It has been a long time coming. We've talked about it for a long time, and it's frustrating that we just haven't seen progress in, you know, right-sizing that funding scheme of what that looks like and making sure it meets the state's and the nation's demographics needs.
So what happens is someone might go to one of our new and expanding medical schools here in Arizona, but then get matched in a residency program somewhere else. They're more likely to stay where they do their residencies, as you said.
KAUFMANN: Yes, we could graduate many medical students and they may not match in Arizona — but they may not match at all in the country. In 2022, nearly 3,000 U.S. medical graduates did not match, and nearly 5,000 international graduates didn't match. So we're talking in 2022, 8,000 would-be doctors who didn't match at all.
Why not? What happened?
KAUFMANN: There's not enough slots, there are not enough funded residency slots for that hands-on training, yhat is necessary, again, to practice as a doctor in the United States.
