On December 18, 2019, the Government Accountability Office (GAO) released a report entitled “Views on Expanding Medicare Graduate Medical Education Funding to Nurse Practitioners and Physician Assistants.”   The Senate Appropriations Committee commissioned the GAO to report on the views of the major nursing, physician assistant (PA) and physician organizations on the possible expansion of Graduate Medical Education (GME) funds to non-physician clinicians. The Committee also requested budgetary estimates for the costs of training PAs and NPs.

GME Funding for Residency is the Rate-Limiting Step in Physician Training

Physicians for Patient Protection (PPP) has serious concerns that legislators have even considered this to be a potential avenue.

GME funding is the rate-limiting step to providing full-fledged and well-trained physicians to the population of the United States.

While medical schools have increased enrollment, the number of Medicare-funded GME residency positions has not increased since 1996- nearly 25 years. Since physicians must complete at least a portion of a residency, and in some states an entire residency, to practice medicine, limiting residency funding has contributed to our nation’s physician shortage.

Biased “Data” Produces Biased Results

Further, PPP is concerned about the accuracy of this report. Instead of relying on primary sources for important data such as education, the GAO utilized information from organizations with the expressed agenda to become independent practitioners. For example, the American Association of Nurse Practitioners (AANP) has the stated goals of “patients will choose NPs as their health care provider” and “NPs will have parity with physicians in…government funding.”

When a report with gross inaccuracies is then potentially used to develop legislation, the report becomes nothing short of dangerous.

Just one of these inaccuracies is found in Figure 1: Example of Education and Training Paths for Physicians, NPs and PAs. For PAs, they have listed 3 years of “hands-on experience” prior to a 2.5 year Master’s degree program. The vast majority of PA schools require just 2000 hours of pre-entry clinical experience, which equates to 1 year of full-time work, and then each program ranges in length from 24 months to 27 months, falling short of what is stated in the GAO report.

In addition, they report that NPs have 4 years of pre-clinical hands-on experience when, now, many NP programs are “direct entry” and require no prior experience as a registered nurse. We have also been unable to find any doctoral program that is five years in duration. For example, a well-known program, Duke University, has a Doctoral of Nursing Practice degree which is awarded after just 5 semesters  (1.5 years) and can be done part-time with only 400 clinical hours following an Master’s of Nursing which can be obtained in just 1-2 years, depending on the program. This falls short of their reported 5 years.

Solving the Physician Shortage Requires Training More Physicians

PPP stands committed to ensuring physician-led care for all Americans. We pledge to educate our legislators on the educational differences between physicians and non-physician clinicians and to advocate for continued and increased funding for physician residency programs. The only way to solve the physician shortage is to provide training for more physicians.