2009 Example numbers (for illustration purposes)
So you can see that by adding funding for 200 residents per year for 3 consecutive years you do have much impact on the number of PGY1 spots and you do not keep up with enrollment increases.
Again this is a moot point because as the AAD article I posted above stated the feds are not planning to put any new money in to create more allopathic or osteopathic spots anyway. That is why the AAD has tried to get corporate sponsors.
I didn't mean to say that the small yearly increases in residencies will keep up with increased medical school enrollees, just that over 10 years, if 200 residency spots are added yearsly this is 2,000 more spots, which helps relieve the stress some on applicants. For some years US medical schools didn't add applicants and the percentage of FMGs/IMGs increased, not so long ago, and now they may be making up for lost time.
What is interesting is that if more residency programs are created then the students are there to accept them, this may be a case of putting the horse before the carriage, i.e. making sure there are enough students to fill the residencies (or at least making sure a good percentage of them are U.S. students.). . .
While 8 billion funds GME now, there is a lot of debate about who should pay for GME, and yes, 8 billion is a drop in the bucket compared to massive stimulus packages, I think 8 billion was dedicated by President Obama just to "get the ball rolling" in terms of getting high speed rail. If the political will is there then spending 4 billion to increase spots even 20 percent is very much possible.
Yes, the U.S. government is in " the red", but macroeconomics in terms of an entity as big as the U.S. government is very complex, although in "the red" the U.S. government will spend trilions of dollars in the coming year, due in part to the fact that foreign countries buy our treasury bonds. If somebody does a study that shows that training new physicians to provide primary care to senior citizens in the community to avoid hospitalization will decrease the cost of medicare in the coming years and decrease the burden on ERs then the government would release billions of dollars to do this. When you operate in such huge sums like the government it is not like a business where if you are in "the red" then you cut back everywhere and force yourself to be frugal. Quite the opposite, may programs expand even in the lean times we find ourselves in, each year the government spends trillions, and if there is a consensus that more physicians are needed it will get done.
The federal government, i.e. basically congress, does not use money on the scale that individuals use it, and in the amounts that government uses it is not really money per se, it is ideas. The Iraq War "costed" one trillion dollars because the president and congress at the time had the "idea" that either planting democracy in the Middle East, riding the world of a dictator, or getting oil, who's ever version you want to believe, was a good idea. This is why political will power comes into play. The real costs of the Iraq War can also be measured in lives lost, and even the possiblity of cheaper oil, the anger at the U.S., when the U.S. government "buys" something as big as a war it can help pull a country out of depression, like world war 2, and change how the game is played. If the government wanted to increase residency spots the issue of whether it is a good idea or not is more important that if the government can afford it, it can believe me, plenty of stuff could be cut if there was an attempt to generate a surplus, but realize a surplus is useless in a way on the scale the government operates, less gets done i.e. perhaps less government contracted work and this alone could create a recession. Which means less people paying taxes which means less surplus, so yes, the government has to keep investing in the country to keep generating taxes NOT profits, in the government's view of "money" it is something that circulates like blood in the body, you often get back money that you put into many different programs in the form of taxes, note that this is VERY different from how individuals use money, you buy a new washing machine and the money is gone, forever.
Only if the proper lobbyists and people with enough power agree that the right idea is to increase residency spots, then will it get done. If the price tage is 2 billion or 8 billion is practically irrelevent. There are tens of thousands of components of the federal budget if not hundreds of thousands, and many go up, many go down, and some stay the same. If the country has a little more debt, and pays attention to that debt, then maybe a slight majority of components get less funding, and many still get more. Its about tweaking the system and creating more residencies to make more doctors to treat the baby boomers is certainly a tweak that could happen in any budget environment. In actuality, if Congress does "give" 8 billion for more residency programs it has actually "bought" something, the right to decide, which it does now in a way, what patients are seen, and can provide incentives for rural practice and also for seeing medicare/medicaid patients, even the money that hospitals get for residency training, it it were taken away could force some hospitals into bankruptcy. So by increasing residency subsidies, the government would also be making it possible for more hospitals to survive, and perhaps allow for more hospitals to be built. Which, would effect the economy in a variety of ways. A study to see if this should be done would besides looking at if there really is or will be a physician shortage, would also look at impact on the whole system, which is really what the government cares about. In the end the government doesn't spend money (a lot of it comes back and the US government can print more money anyway and make money cheaper), but really support certain ideas and greases the system how it likes. Like toxic assets, which nobody knows what they are worth, nobody really knows how much 8 billion for GME is "worth" compared to what 8 billion for Iraq is worth. There is even a debate if government should fund GME at all . . . the government doesn't do it for profit, but to grease hospitals i.e. keep them running and to help make more physicians, in effect it is the government saying you should be doing it this way as there is a lot government input into residency programs. If there was a consensus to "privatize" the residency system then, yes, there is enough money for private coporations to start residency programs, i.e. hospitals in exchange for work and maybe even a committment to work for a corporation i.e. hospital group, and other reasons, . . . the government may actually get more bang for the buck by "financing" GME as the 8 billion buys more influence and control than 8 billion for our state parks . . .
You can give 8 billion to have credit markets unfrozen, but this is worth more than 8 billion for a new fighter aircraft that is rendered obsolete as it has been a long time since the US has been engaging in dog fights. This is why spending in government is so complicated, you aren't spending money, so much as renting or leasing an undefined entity which may grease the system, i.e. the world, or may cause problems, . . . nobody really knows how much 8 billion in GME funding IS, sure it is 8 billion, but is that as good as 8 billion to getting the ground going on high speed rail? Maybe. This is not exactly the same as a person on a budget prioritizing as these are all complicated investments and the budget is flexible. Even so, a lot residency programs exceeded their IME caps, I think for total around 4,000 residents so there is a motivating factor in terms of a perception of a physician shortage. Residency spots grew 4 percent between 1998 and 2004, largely funded by teaching hospitals funding them privately.
it's really quite sad that it's getting harder for people to wind up with their preferred residency when *all* of us have worked hard and made sacrifices to get to the point of graduating as doctors. 
