Graduate Medical Education

Resident physicians who graduate from medical school typically spend three to seven years in graduate medical education (GME) training at teaching hospitals and their associated ambulatory (outpatient) settings. The CAP develops and provides high-caliber educational meetings, trainings, and workshops to support pathology and laboratory professionals.

The vast majority of GME funding comes from the federal Medicare program. The Medicare program pays for direct GME – costs of educating residents – and indirect medical education to cover the higher costs teaching hospitals incur.

The Balanced Budget Act of 1997 limited the number of allopathic and osteopathic medical residents counted for purposes of calculating Medicare reimbursement to each hospital's 1996 resident count. Additionally, the Balanced Budget Refinement Act of 1999 increased the limit for rural teaching hospitals to equal 130% of each rural teaching hospital's 1996 resident count. These caps reflect the health care workforce in 1996 and do not reflect how health care needs have changed over the past 20 years.

Impact on the Specialty of Pathology

The CAP projects a substantially lower supply of pathologists in the next 15 years due to a projected retirement cliff. The number of physicians entering the pathology workforce each year will be far less than the number needed to keep up with the approaching retirement cliff. Pathology slots must be protected to ensure there is not an adverse impact on health care delivery. Unfortunately, there is little awareness among policymakers about the pathology retirement cliff and the impact it could have on patients. Overall GME funding needs to be maintained, if not increased, to help protect funding for residency slots for pathology.

Ongoing Efforts

The CAP’s Policy Roundtable continues to work on a paper that draws out public policy implications from CAP's forecast of pathologist shortages. In 2016, the Board of Governors approved a Pathologist Workforce Strategy focusing on five types of activities:

• Advocating to maintain the current allocation of residency slots to pathology
• Conducting regular data collection and analysis to understand trends affecting the supply of, and the demand for, pathologists
• Regularly assessing the extent to which residency training programs are training new pathologists in the skills needed in a changing health care environment
• Reducing erosion of demand for pathologist services by protecting pathologist scope of practice
• Providing tools to help pathology programs maintain their residency slots