Guest column: Legal barriers create Michigan’s doctor shortage

By Mark D. DuBay

In "Michigan gets med-school boom, doctor bust," the author correctly points out that a doctor may not be fully licensed in this state unless a period of post graduate education, also known as a "residency," is first completed. Under section 333.17031 of the Public Health Code, a doctor is to "complete a period of postgraduate education to attain proficiency in the practice of the profession" before a full license is granted.

The residency requirement was originally intended to give doctors additional experience and training after medical school. It was never intended to limit the number of licensed doctors. Regardless of its original intent, the residency requirement effectively limits the number of doctors licensed in Michigan. If a doctor successfully graduates from medical school and passes all three steps of the United States Medical Licensing Examination (USMLE), the doctor is nonetheless ineligible for a license.

When it was adopted in 1965, Medicare became the primary source of funding residency programs. These funds have been "frozen" since 1996. This has reduced the pool of doctors available to serve Michigan residents. It is unlikely that funds from this source will be increased any time soon. The American Association of Medical Colleges published a report in 2008 indicating that, even if residency programs were funded at a level described as "robust", doctors would still be licensed in numbers insufficient to service the projected need.

The medical profession is unusual, if not unique, in requiring "post graduate education" as a licensing condition. Most other major professions merely require obtaining a professional degree and passing national exams to prove competency. A review of state statutes and the administrative code shows that this is the rule overwhelmingly. Once educated and tested, a license is granted to accountants, dentists, engineers, lawyers, pharmacists, or other licensed professionals without further training.

Fitzhugh Mullan quotes experts criticizing the length of medical education: "To the four years of ‘undergraduate’ medical education that were the norm of the early 20th century have been added three to seven more years of ‘graduate’ medical education (residency), depending on the specialty being pursued. In 1988 Robert Ebert, dean emeritus of the Harvard Medical School, and Columbia University health economist Eli Ginzberg argued that medical education had become unnecessarily lengthy."

Michigan licensing law must be reconsidered. Those doctors who wish to become specialists should have the residencies and become board certified. Those who wish to simply practice medicine as a primary care physician should be allowed "to attain proficiency in the practice of the profession" by working under the supervision of fully licensed doctors.

Michigan is not alone in this problem, and each state controls its own licensing laws and therefore controls solutions. The authority of Physician’s Assistants in Michigan was increased this past November with the adoption of Public Act 210 of 2011. Since doctors who have been educated and tested can do nothing without a residency and residencies for all those eligible are not being provided, medical licensing laws should be revisited, just as they were for Physician’s Assistants.

If a U.S. citizen is a medical school graduate, has passed the United States Medical Licensing Examination and is eligible for licensure if a residency were provided, it is time to license this doctor. In a time of shortage, it makes no sense to waste medical talent. One does not pass the United States Medical Licensing Examination without being competent.

Other pathways to licensure must be created if Michigan’s physician shortage is to be solved. It may be done by working in harmony with the current residency system, which may be used to train specialists, not the general practitioner. If a dean emeritus of the Harvard Medical School thinks medical education is unnecessarily lengthy, perhaps it is time to listen.