WASHINGTON, D.C. – Rep. Adrian Smith (NE-03) delivered the following opening statement at a Ways & Means Health Subcommittee hearing on examining innovative ways to train America’s health care workforce, with a focus on serving rural and underserved communities and leveraging technology to encourage healthier living:

As prepared for delivery.

“Good morning and thank you to the witnesses for being here to discuss an important issue: Advancing the next generation of America’s health care workforce.

“I am filling in today for our Subcommittee Chairman, Mr. Buchanan, who cannot be here this morning. He has a number of concerns about this issue, as do I, and I’m glad he called this hearing together.

“Our nation is facing a very real problem – a rapidly depleting health care workforce. 

“By 2037, the U.S. will see a shortage of 187,000 physicians.

“Nearly half of all practicing physicians will retire in the next decade. 

“83 million Americans live in an area with too few primary care physicians. 

“Rural communities are even more vulnerable to workforce shortage issues, with 60 percent fewer physicians for every 10,000 patients, when compared with urban cities.

“Medical school prepares students to help fill this shortfall, but residency programs after graduation deliver practical instruction and enable doctors to deliver the best patient care.

“This Graduate Medical Education, or ‘GME,’ is a critical component of physician training.

“Medicare is a major contributor to GME, supporting nearly 80 percent of residency training nationwide, and paying more than $20 billion annually to teaching hospitals.

“However, this funding is increasingly being directed to large coastal hospitals while health care workforce shortages persist across the country.

“Rural and underserved communities in particular face unique barriers to establishing programs and training residents.

“Rural hospitals must overcome a lack of resources, staff, and patient volume to establish new residency programs, while simultaneously getting reimbursed less than their urban counterparts.

“Congress recognized this gap and recently funded more than 1,000 new GME slots, with 10 percent specifically reserved for rural areas, but, concerningly, large urban hospitals have exploited a Medicare loophole and have collected 97 percent of the 800 slots distributed so far.

“This behavior perpetuates the already stark geographic disparities in GME as research shows that doctors are five times more likely to stay and practice in a rural area if they train there. Yet only two percent of residencies can be found in rural America.

“At the same time, we need to train new physicians to better address the chronic disease epidemic by focusing on prevention, nutrition, and incorporating modern technology.

“Six out of 10 Americans have a chronic disease, and 90 percent of our health care dollars go towards managing these diseases.

“Unfortunately, most residents receive minimal training in prevention. In fact, only 14 percent of residency programs have a required nutrition curriculum.

“If we are serious about strengthening our health care system, increasing our supply of physicians, and managing chronic disease, we must start with how and where we train our physicians.

“I am encouraged by the success of some efforts, such as Rural Track Programs, and hospital residencies that are incorporating technology and lifestyle education, but I know there is more we can do. 

“I look forward to discussing this important topic with my colleagues today so this Committee can lead on targeted solutions to grow our health care workforce.”