AMA advocacy: Graduate Medical Education and student loans

The American Medical Association is committed to supporting medical students and residents as they attend school and enter their training years. 

As part of this the AMA believes that the cost of a medical education should never pose a barrier to a career in medicine and has long-standing concerns about the high and increasing costs of medical education and supports efforts to ensure that individuals are offered fair loan terms and are provided with the ability to make meaningful progress towards paying off their student loans. In alignment with this, the AMA collaborates with our partners in the Federation of Medicine, and engages in consistent and ongoing advocacy work in the public- and private-, to ease the financial burden medical students, residents and physicians by:

• Promoting stable funding for medical education programs to limit tuition increases.
• Creating resources to increase financial literacy surrounding medical school debt.
• Urging for the expansion of service-based scholarships and loan forgiveness programs.
• Advocating for consistent, reliable, and affordable federal student loans and repayment plans.

With current and projected physician shortages across the country, the AMA is also deeply committed to ensuring adequate access to care and training slots. Therefore, the AMA has been working diligently to:

• Remove the cap on residency slots.
• Provide additional time for programs before a cap is set.
• Expand training programs.
• Find innovative ways to support residents in rural and underserved areas.
• Support the expansion of diverse teaching and supervision requirements.

Sustained, long-term investments in the physician workforce are necessary to help care for our nation’s patients and ensure that our physicians can successfully complete their education and training. As such, the AMA is working diligently to help ensure that the necessary resources and supports are in place to educate and train our next generation of physicians.

2025

• On May 28, the AMA signed onto a letter asking Congress for $778 million in FY 2026 funding for the CHGME program.
• On May 20, the AMA sent a letter on numerous parts of the combined legislation accompanying the Concurrent Resolution on the Budget for Fiscal Year 2025, specifically House Concurrent Resolution 14. The letter addressed numerous issues within the legislative proposal including the cap on borrowing for student loans, the elimination of certain types of student loans offered by the federal government, the removal of residency time from the Public Service Loan Forgiveness (PSLF) program, and the repayment plans that would be created.
• On May 19, the AMA sent a letter in support of S. 1380, the “Specialty Physicians Advancing Rural Care Act,” or the “SPARC Act,” which would amend the Public Health Service Act to authorize a loan repayment program to encourage specialty medicine physicians to serve in rural communities experiencing a shortage of these vital physicians.
• On April 30, the AMA sent a comment letter urging the administration to consider the importance of the PSLF program for physician borrowers and encouraging the Department to make the PSLF program more widely available to physician borrowers while also making other income-based repayment plans more accessible.
• On April 29, the AMA signed onto letters to the House and Senate in support of additional funding in FY 2026 for the Indian Health Service including increased loan repayment and scholarships, more staff quarters, and additional medical and diagnostic equipment for the IHS.
• On April 14, the AMA sent a letter to the Department of Education and the Small Business Administration noting concerns about the uncertainty surrounding the income-driven repayment (IDR) plans, the potential changes proposed to the PSLF program, and the potential unintended consequences of moving these programs to the U.S. Small Business Administration.
• On April 10, the AMA signed onto a letter in support of H.R. 2332 the “SHARE Act” which would a simplify and streamline the process for criminal background checks required under interstate occupational licensure compacts.
• On April 2, the AMA sent a letter in support of S. 942, the “Resident Education Deferred Interest (REDI) Act,” which would allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program.
• On April 2, the AMA sent a letter in support of H.R. 2028, the “Resident Education Deferred Interest (REDI) Act,” which would allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program.
• On March 27, the AMA signed on to a letter thanking Congress for the reintroduction of the “Resident Education Deferred Interest (REDI) Act” (S. 942/H.R. 2028) that, if passed, would allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program.
• On March 19, the AMA sent a letter offering our support for S. 632, the “IHS Workforce Parity Act of 2025.” The IHS Workforce Parity Act would amend the Indian Health Care Improvement Act to allow Indian Health Service (IHS) scholarship and loan recipients to fulfill service obligations through half-time clinical practice which would ultimately bring much needed additional providers to American Indians and Alaska Natives through the IHS.
• On Jan. 31, the AMA sent a response to a request for information (RFI) from the Senate Finance Committee on draft legislation to improve the Medicare GME program.

2024

• On Oct. 15, the AMA sent a response to a request for information (RFI) that was included in the 2025 IPPS final rule. CMS received a variety of comments in response to its proposal surrounding how to appropriately modify the criteria for new residency programs. Due to a lack of consensus among interested parties, CMS did not finalize its proposal and instead, in an effort to achieve greater consensus on this issue, CMS initiated another RFI seeking comments on the appropriate criterion regarding newness of residents which the AMA commented on.
• On Sept. 5, the AMA submitted comments on the CY 2025 Physician Fee Schedule. As part of these comments, the AMA recommended a permanent expansion of supervision of residents via audio-video real-time communications technology.
• On Sept. 5, the AMA signed onto a letter supporting Sections 12 and 13 in H.R.8318 the “Tribal Tax and Investment Reform Act of 2024,” which would amend the tax code to provide health care professionals who receive student loan repayments and scholarships from the Indian Health Service (IHS) the same tax-free status as those who receive National Health Service Corps (NHSC) loan repayments.
• On Aug. 6, the AMA sent a letter in support of sections 12 and 13 of H.R. 8318, the “Tribal Tax and Investment Reform Act of 2024.” These sections of the bill mirror the language from the “Indian Health Service Health Professions Tax Fairness Act of 2022,” which the AMA supported in the 117th Congress, and which would amend the Internal Revenue Code (IRC) to exclude payments made under the Indian Health Service Loan Repayment Program (IHS LRP) and certain amounts received under the Indian Health Professions Scholarships Program (IHPSP) from gross income payments.
• On July 23, the AMA sent a letter urging the Centers for Medicare & Medicaid Services, the U.S. Department of Veterans Affairs, the U.S. Department of Defense, and the Health Resources and Services Administration to issue an annual holistic assessment of total GME funding for each year, including how Direct GME funds are allocated on a per resident or fellow basis.
• On June 24, the AMA signed onto a letter responding to the Bipartisan Medicare Graduate Medical Education (GME) Working Group’s Draft Proposal Outline and Questions for Consideration. While numerous policy solutions are needed to sustain and bolster the physician workforce, increased Medicare support for GME is a key component to stabilizing the workforce expansion.
• On June 24, the AMA submitted comments on the Senate Finance Committee’s draft policy proposal and specific questions for consideration on policies related to the Medicare Graduate Medical Education (GME) program.
• On June 10, the AMA submitted comments to CMS on the Fiscal Year 2025 Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) and the Long-Term Care Hospital Prospective Payment System (LTCH PPS) supporting the expansion of resources and the removal of barriers to the training and retention of obstetric care physicians, especially in rural and underserved areas. The AMA also supported the allocation of GME slots to strategically address the most pressing needs within the health care system, including the shortage of mental health professionals. The AMA urged CMS to adopt a distribution framework that considers the specific needs of communities and the capacity of institutions to provide high-quality education and training to residents.
• On May 20, the AMA signed onto a letter to the House urging for several significant budget increases that will dramatically improve the delivery of health care to American Indians and Alaska Natives.
• On May 20, the AMA signed onto a letter to the Senate urging for several significant budget increases that would dramatically improve the delivery of health care to American Indians and Alaska Natives.
• On May 17, the AMA commented on the “Student Debt Relief for the William D. Ford Federal Direct Loan Program (Direct Loans), the Federal Family Education Loan (FFEL) Program, the Federal Perkins Loan (Perkins) Program, and the Health Education Assistance Loan (HEAL) Program” proposed rule. The AMA was very supportive of the waivers and appreciated the Administration's efforts to ensure that individuals are offered fair loan terms and are provided with the ability to make meaningful progress towards paying off their student loans.
• On May 16, the AMA submitted a Statement for the Record to the U.S. Senate Committee on Finance as part of the hearing entitled, “Rural Health Care: Supporting Lives and Improving Communities.” The statement covered a number of issues including recommendations on ways to increase and retain the physician workforce, especially in rural communities.
• On May 15, the AMA signed onto a letter asking the House and Senate for additional funding in FY 2025 for the Children’s Hospitals Graduate Medical Education (CHGME) program.
• On May 14, the AMA singed onto a letter expressing strong support for the “Rural Residency Planning and Development Act of 2024” (H.R. 7855). This bill would ensure the continuity and expansion of the Rural Residency Planning and Development (RRPD) pilot program, which has already made a significant contribution to the long-term sustainability of rural healthcare access.
• On May 1, the AMA sent a letter offering our support for S. 3968, the “Community Training, Education, and Access for Medical Students (Community TEAMS) Act of 2024.” The Community TEAMS Act would amend the Public Health Service Act to provide grants for training opportunities for medical students in rural health clinics, federally qualified health centers, and health care facilities located in medically underserved communities.
• On April 30, the AMA sent a letter offering our support for S. 3022, the “IHS Workforce Parity Act of 2023.” The IHS Workforce Parity Act would amend the Indian Health Care Improvement Act to allow Indian Health Service scholarship and loan recipients to fulfill service obligations through half-time clinical practice which would ultimately bring much needed additional providers to American Indians and Alaska Natives through the Indian Health Service (IHS).
• On April 11, the AMA provided verbal support for H.R. 1310 the “SHARE Act.” This bill would authorize the use of FBI criminal history record information for administration of interstate compacts and was endorsed by FSMB.
• On March 26, the AMA sent a letter offering support for H.R. 7258, the “Community Training, Education, and Access for Medical Students (Community TEAMS) Act.” The Community TEAMS Act would amend the Public Health Service Act to provide grants for training opportunities for medical students in rural health clinics, federally qualified health centers, and health care facilities located in medically underserved communities.
• On March 13, the AMA signed onto a letter in support of the “Substance Use Disorder Workforce Act of 2024” (H.R. 7050). This thoughtful, bipartisan legislation would provide Medicare support for an additional 1,000 new graduate medical education (GME) positions over five years in hospitals that have, or are in the process of establishing, accredited residency programs in addiction medicine, addiction psychiatry, or pain medicine and their prerequisite programs.
• On Feb. 5, the AMA signed onto a letter to the House and Senate asking for additional funding to address chronic clinical staff shortages across Indian Country through graduate medical education (GME) programming.
• On Feb. 1, the AMA sent a letter in support of H.R. 7050, the “Substance Use Disorder Workforce Act,” which would provide 1,000 additional Medicare-supported graduate medical education (GME) positions in hospitals that have, or are in the process of establishing, accredited residency programs in addiction medicine, addiction psychiatry, or pain medicine.

2023

• On Nov. 27, the AMA signed onto a letter in support of the “Specialty Physicians Advancing Rural Care (SPARC) Act.” (S. 705/ H.R. 2761). This bipartisan legislation would establish a new loan repayment program to incentivize specialty physicians to practice in rural areas and expand access for many Americans who do not have specialty physicians available to treat them.
• On Oct. 19, the AMA submitted a Statement for the Record to the U.S. House of Representatives Committee on Energy and Commerce Subcommittee on Health as part of the hearing entitled “What’s the Prognosis? Examining Medicare Proposals to Improve Patient Access to Care & Minimize Red Tape for Doctors.” This statement covers a number of issues including GME and workforce issues that the AMA would like addressed to strengthen the physician workforce.
• On Oct. 5, the AMA sent a letter commenting the House Committee on Ways and Means’ request for information (RFI) on ways to improve health care in rural and underserved areas. A number of subject areas were covered including needed improvements for the physician workforce.
• On Oct. 4, the AMA sent a letter asking that the Indian Health Service (IHS) establish an Office of Academic Affiliations responsible for coordinating partnerships with the Liaison Committee on Medical Education, the Commission on Osteopathic College Accreditation, accredited medical schools, and residency programs accredited by the Accreditation Council for Graduate Medical Education. The AMA encouraged IHS to develop funding streams to promote rotations and learning opportunities at IHS, Tribal, and Urban Indian Health Programs. The AMA also encouraged the IHS to evaluate existing regulatory and licensure opportunities and barriers that physicians face when seeking to provide health care services for American Indians, Alaska Natives, and Native Hawaiians.
• In July 2023, the AMA created an overview of information concerning student loans including the Supreme Court decision, the new federal regulations concerning student loan repayments, and next steps that the Biden Administration was working towards.
• On June 9, the AMA sent a letter commenting on the 2024 Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) and the Long-Term Care Hospital Prospective Payment System (LTCH PPS). The letter commented on a number of issues and supported the proposed changes to Graduate Medical Education (GME) payments for Rural Emergency Hospitals (REHs) and urged CMS to address the ongoing challenges associated with funding for non-physician training to preserve adequate physician training opportunities and further urged CMS to implement safeguards to ensure accurate updates to GME funding in the future.
• On May 22, the AMA signed onto a letter supporting the “Resident Physician Shortage Reduction Act of 2023” (S. 1302). This bipartisan legislation is crucial to expanding the physician workforce and to ensuring that patients across the country are able to access quality care from providers.
• On May 9, the AMA sent a letter voicing our support for S.1403 the “Medical Student Education Authorization Act of 2023.” This legislation would reauthorize the Medical Student Education Program, which provides grants to public institutions of higher education to expand or support graduate education for physicians and prioritizes grants to states with the most severe primary care provider shortages. In particular, the AMA applauds the legislation for extending funding for the Medical Student Education Program through 2025, permitting grants of at least $1,000,000 annually, and authorizing grant recipients to receive funding for up to five years.
• On May 9, the AMA sent a letter in strong support of H.R. 2389, the “Resident Physician Shortage Reduction Act of 2023.” This bipartisan legislation would gradually raise the number of Medicare-supported graduate medical education (GME) positions by 2,000 per year for seven years, for a total of 14,000 new slots. A share of these positions would be targeted to hospitals with diverse needs including hospitals in rural areas, hospitals serving patients from health professional shortage areas (HPSAs), hospitals in states with new medical schools or branch campuses, and hospitals already training over their caps.
• On May 9, the AMA sent a letter in strong support of S. 1302, the “Resident Physician Shortage Reduction Act of 2023.” This bipartisan legislation would gradually raise the number of Medicare-supported graduate medical education (GME) positions by 2,000 per year for seven years, for a total of 14,000 new slots. A share of these positions would be targeted to hospitals with diverse needs including hospitals in rural areas, hospitals serving patients from health professional shortage areas (HPSAs), hospitals in states with new medical schools or branch campuses, and hospitals already training over their caps.
• On May 8, the AMA signed onto a letter offering our enthusiastic support for the “Resident Physician Shortage Reduction Act of 2023” (H.R. 2389). This bipartisan legislation is crucial to expanding the physician workforce and to ensuring that patients across the country are able to access quality care from providers.
• On May 5, the AMA sent a letter in support of S. 705, the “Specialty Physicians Advancing Rural Care Act,” or the “SPARC Act,” which would amend the Public Health Service Act to authorize a loan repayment program to encourage specialty medicine physicians to serve in rural communities experiencing a shortage of these vital physicians.
• On May 5, the AMA sent a letter in support of H.R. 2761, the “Specialty Physicians Advancing Rural Care Act,” or the “SPARC Act,” which would amend the Public Health Service Act to authorize a loan repayment program to encourage specialty medicine physicians to serve in rural communities experiencing a shortage of these vital physicians.
• On May 5, the AMA sent a letter urging the Centers for Medicare & Medicaid Services (CMS) to permanently allow the supervision of residents in teaching settings through audio/video real-time communications technology. The AMA appreciated CMS’s decision in the 2021 Physician Fee Schedule to permanently allow virtual supervision of residents for certain types of services in non-metropolitan areas; however, we believed it was vital to permanently continue this additional supervision option regardless of location.
• On March 22, the AMA sent a letter voicing our support for HR 3046 the “Medical Student Education Authorization Act of 2023.” This legislation would reauthorize the Medical Student Education Program, which provides grants to public institutions of higher education to expand or support graduate education for physicians and prioritizes grants to states with the most severe primary care provider shortages. In particular, the AMA applauded the legislation for extending funding for the Medical Student Education Program through 2025, permitting grants of at least $1,000,000 annually, and authorizing grant recipients to receive funding for up to five years.
• On March 20, the AMA submitted comments to the Senate Committee on Health, Education, Labor and Pensions responding to their request for comment concerning health care workforce shortages. We discussed rural hospitals, physician burnout, prior authorization, loan repayment and scholarship programs, support for physician-led teams and physician payment.
• On March 16, the AMA endorsed S.54 the "Strengthening America's Health Care Readiness Act" which would address health workforce shortages through additional funding for the National Health Service Corps, and to establish a National Health Service Corps Emergency Service demonstration project.
• On March 15, the AMA provided verbal support for S.862 the “Restoring America’s Health Care Workforce and Readiness Act.” The bill would reauthorize and increase the mandatory funding stream for the NHSC.  The bill would provide a 3-year extension (funds were set to expire Sept 30, 2023) and grow the funding level from $310M to $625M in FY24 and up to $825M in FY26 to help address the nation’s dire workforce shortages and restore/sustain HRSA’s awardee rate from recent years.  The bill also included the demonstration project from S.54 in the 116^th Congress between the National Disaster Medical Services and NHSC, in order to test whether additional loan repayment for service in the NDMS would help to bolster preparedness.
• On March 15, the AMA signed onto a letter in support of the Children’s Hospitals Graduate Medical Education (CHGME) program asking for the provision of $738 million in Fiscal Year (FY) 2024 funding for the program.
• On March 1, the AMA signed onto a support letter for the “Resident Education Deferred Interest (REDI) Act” (H.R. 1202) that, if passed, would allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program.
• On Feb. 10, the AMA sent a letter commenting on the Improving Income-Driven Repayment for the William D. Ford Federal Direct Loan Program proposed rule. The AMA supported efforts to ensure that individuals are offered fair loan terms and are provided with the ability to make meaningful progress towards paying off their student loans.

2022

• On Oct. 25, the AMA sent informal comments to the Senate Finance Committee on their Enhancing the Mental Health Workforce discussion draft. These comments touched on the addition of GME slots including 400 new psychiatry slots, HPSA bonus programs, and more.
• On Aug. 29, the AMA provided comments on the Centers for Medicare & Medicaid Services Conditions of Participation for Rural Emergency Hospitals (REH) and Critical Access Hospital (CoP) Updates Proposed Rule. The AMA supported the goals of the Proposed Rule to ensure equitable access to high quality care in rural communities and noted the importance of this proposed rule as rural hospitals continue to close leaving vast care deserts.
• On Aug. 12, the AMA sent a letter commenting on the Student Assistance General Provisions, Federal Perkins Loan Program, Federal Family Education Loan Program, and William D. Ford Federal Direct Loan Program proposed rule. The AMA commented on the definition of employee or employed and the need to change this so that physicians that are impacted by the corporate practice of medicine can access the PSLF benefits. We also commented in the need to extend the current PSLF waiver, the definition of qualifying employer, and the scope of practice issues surrounding the total and permanent disability determinations.
• On July 29, the AMA provided information regarding the Department of Health and Human Services’ (HHS) Initiative To Strengthen Primary Health Care.
• On June 23, the AMA sent a letter in support of S. 4330, the “Specialty Physicians Advancing Rural Care Act,” or the “SPARC Act,” which would amend the Public Health Service Act to authorize a loan repayment program to encourage specialty medicine physicians to serve in rural communities experiencing a shortage of specialty medicine physicians.
• On May 3, the AMA sent a letter to the Senate supporting S. 2874 the “Indian Health Service Health Professions Tax Fairness Act of 2022.” This bill would amend the Internal Revenue Code to exclude payments made under the Indian Health Service Loan Repayment Program (IHS LRP) and certain amounts received under the Indian Health Professions Scholarships Program (IHPSP) from gross income payments.
• On May 3, the AMA sent a letter to the House supporting H.R. 7539 the “Indian Health Service Health Professions Tax Fairness Act of 2022.” This bill would amend the Internal Revenue Code to exclude payments made under the Indian Health Service Loan Repayment Program (IHS LRP) and certain amounts received under the Indian Health Professions Scholarships Program (IHPSP) from gross income payments.
• On March 8, the AMA provided comments on the Department of Veterans Affairs (VA) Proposed Rule “RIN 2900- AR01—VA Pilot Program on Graduate Medical Education and Residency.” Due to the ever-increasing physician workforce shortage and the need for additional residency programs and slots, the AMA supported the VA pilot program which would help to expand GME in the VA.
• On Feb. 25, the AMA sent a letter offering our comments to the Centers for Medicare & Medicaid Services (CMS) on the 2022 Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS). Specifically, our comments focused on Graduate Medical Education (GME) and other related provisions contained in the final rule.
• On Feb. 18, the AMA sent a letter supporting S. 3658, the “Resident Education Deferred Interest (REDI) Act,” which would allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program.
• On Feb. 4, the AMA signed onto a letter urging the Senate to include the text of the bipartisan “Bolstering Infectious Outbreaks (BIO) Pandemic Workforce Act” (S. 3244) in the PREVENT Pandemics Act.

2021

• In Dec. 2021, the AMA provided a press release and verbal support for H.R. 6397, the “Medical Student Education Authorization Act of 2022,” which would authorize HRSA’s Medical Student Education program for five years. The program would provide grants to public institutions of higher education to expand or support graduate education for medical students preparing to become physicians in the top quintile of states with a projected primary care provider shortage in 2025.
• On Dec. 1, the AMA signed onto a letter urging Congress to include the bipartisan “Bolstering Infectious Outbreaks (BIO) Preparedness Workforce Act of 2021” in upcoming pandemic preparedness legislation. This bill would help alleviate workforce shortages to strengthen our preparedness for future public health emergencies and build the next generation of infectious diseases (ID) experts and laboratory professionals who will respond to emerging and ongoing health threats and epidemics.
• On Nov. 11, the AMA submitted a letter offering our recommendations in response to a request for information (RFI) from the Senate on improving access to health services for individuals with mental health and substance use disorders (SUD). We noted the additional needs of residents and physicians and how fulfilling these needs could strengthen the workforce in this area.
• On Oct. 22, the AMA signed onto a letter expressing our support for the “Bolstering Infectious Outbreaks (BIO) Preparedness Workforce Act of 2021,” H.R. 5602. This bill would help alleviate workforce shortages to strengthen our preparedness for future public health emergencies and build the next generation of infectious diseases (ID) experts and laboratory professionals who will respond to emerging and ongoing health threats.
• On Sept. 21, the AMA provided information to the Department of Education regarding the Public Service Loan Forgiveness (PSLF) program. The AMA urged the Department to consider the importance of the PSLF program for physician borrowers and encouraged the Department to make the PSLF program more widely available to physician borrowers as well as provide stronger communication to borrowers so they can successfully complete the PSLF program.
• On Sept. 1, the AMA joined a sign-on letter urging Congress to include policies that would increase Medicare support for GME in the budget reconciliation legislation and reinforcing our support for the “Resident Physician Shortage Reduction Act of 2021.” Soon after this letter was sent HHS announced the availability of $19.2 million to expand the training of primary care residents in rural and underserved communities.  
• On Aug. 30, the AMA sent a letter conveying our ongoing commitment to reform and improve our nation’s health care system, as well as providing our perspective on health care issues related to the budget reconciliation proposal. This letter touches on many topics including GME and IMG issues.
• On July 1, the AMA send a letter supporting H.R. 4122, the “Resident Education Deferred Interest (REDI) Act,” which would allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program.
• On June 28, the AMA signed on to a letter urging CMS to finalize the Alternative 2 methodology for distribution of the new 1,000 GME slots in the FY 2022 Inpatient Prospective Payment System (IPPS) proposed rule, with modifications, and increase the number of full time equivalent (FTE) slots awarded per hospital for FY 2023 and all succeeding years.
• On June 28, the AMA provided comments about how the new 1,000 GME slots should be distributed via the FY 2022 Inpatient Prospective Payment System (IPPS) proposed rule.
• On June 23, the AMA sent a letter to the House voicing our support for the “Physician Shortage GME Cap Flex Act of 2021.” This legislation would help to address our national physician workforce shortage by providing teaching hospitals an additional five years to set their Medicare Graduate Medical Education (GME) cap if they establish residency training programs in primary care or specialties that are facing shortages.
• On June 23, 2021, the AMA sent a letter to the Senate voicing our support for the “Physician Shortage GME Cap Flex Act of 2021.” This legislation would help to address our national physician workforce shortage by providing teaching hospitals an additional five years to set their Medicare Graduate Medical Education (GME) cap if they establish residency training programs in primary care or specialties that are facing shortages.
• On June 10, the AMA sent a letter voicing our support for the “Doctors of Community Act” or the “DOC Act.” This legislation would permanently authorize the Teaching Health Center Graduate Medical Education (THCGME) program. As such, this legislation is vitally important in ensuring that patients in underserved areas continue to have access to the care that they need.
• On May 25, the AMA sent a letter voicing our support for S. 1438, the “Opioid Workforce Act of 2021,” which would provide 1,000 additional Medicare-supported graduate medical education (GME) positions in hospitals that have, or are in the process of establishing, accredited residency programs in addiction medicine, addiction psychiatry, or pain medicine.
• On May 24, the AMA sent a letter supporting H.R. 3441, the “Substance Use Disorder Workforce Act,” which would provide 1,000 additional Medicare-supported graduate medical education (GME) positions in hospitals that have, or are in the process of establishing, accredited residency programs in addiction medicine, addiction psychiatry, or pain medicine.
• On May 18, the AMA signed onto a letter asking that federal support for physician training be included in upcoming legislative efforts to improve the nation’s infrastructure and reaffirming our support for the “Resident Physician Shortage Reduction Act of 2021” which asks for 14,000 additional Medicare-supported GME positions.
• On May 13, the AMA sent a letter supporting S. 1443, the “Retirement Parity for Student Loans Act.” In 2020, about 42 million Americans, or one in eight, had student loans with the entire amount of student debt equaling around $1.5 trillion. With Americans feeling the weight of student loan debt, many choose to forgo contributing to their retirement plans, jeopardizing their future financial security. The Retirement Parity for Student Loans Act would permit 401(k), 403(b), SIMPLE, and governmental 457(b) retirement plans to make voluntary matching contributions to workers as if their student loan payments were salary reduction contributions. This crucial legislation was passed into law.
• On May 13, the AMA sent a letter supporting H.R. 2917, the “Retirement Parity for Student Loans Act.” In 2020, about 42 million Americans, or one in eight, had student loans with the entire amount of student debt equaling around $1.5 trillion. With Americans feeling the weight of student loan debt, many choose to forgo contributing to their retirement plans, jeopardizing their future financial security. The Retirement Parity for Student Loans Act would permit 401(k), 403(b), SIMPLE, and governmental 457(b) retirement plans to make voluntary matching contributions to workers as if their student loan payments were salary reduction contributions. This crucial legislation was passed into law.
• On April 8, the AMA sent a letter supporting S. 924, the “Rural America Health Corps Act.” This much-needed legislation would establish a demonstration program to provide payments on qualified loans for individuals eligible for, but not currently participating in, the National Health Service Corps (NHSC) Loan Repayment Program who agree to a five-year period of obligated full-time service in a rural health professional shortage area.
• On April 7, the AMA sent a letter supporting the “Student Loan Forgiveness for Frontline Health Workers Act,” and urging the U.S. House of Representatives to pass this legislation. Physicians, residents, medical students, and other health care professionals are playing a critical role in responding to the COVID-19 crisis and putting their health on the line caring for the sickest patients. As such, due to their selfless actions in the face of a national emergency, physicians, residents, medical students, and other health care professions who perform work to combat, control, and recover from COVID-19 should be provided with meaningful relief in the form of student loan forgiveness.
• On March 24, the AMA signed onto a letter in support of the “Resident Physician Shortage Reduction Act.” This bipartisan legislation is crucial to expanding the physician workforce and to ensuring that patients across the country are able to access quality care from providers. The Resident Physician Shortage Reduction Act of 2021 would gradually increase the number of Medicare-supported GME positions by 2,000 per year for seven years, for a total of 14,000 new slots. A share of these positions would be targeted to hospitals with diverse needs including hospitals in rural areas, hospitals serving patients from health professional shortage areas (HPSAs), hospitals in states with new medical schools or branch campuses, and hospitals already training over their caps.
• On Feb. 2, the AMA sent a letter voicing our support for S. 54, the “Strengthening America’s Health Care Readiness Act.” This much needed legislation would provide additional funding for the National Health Service Corps (NHSC), the Nurse Corps, and establish a National Health Service Corps Emergency Service demonstration project. Shortly after this letter was sent the Administration invested $1.5B in expanding the health workforce and improving critical clinical care in underserved communities.
• On Jan. 28, the AMA signed onto a letter in support of the inclusion of the bipartisan “Strengthening America’s Health Care Readiness Act,” S. 54, within the next coronavirus response package. This important legislation would provide additional and desperately needed funding for the National Health Service Corps (NHSC) and Nurse Corps scholarship and loan repayment programs.
• On Jan. 27, the AMA signed on letter thanking the Senate for investing in physician training by adding 1,000 new Medicare-supported graduate medical education (GME) positions in the Consolidated Appropriations Act, 2021.

2020

• On Oct. 4, the AMA supported permanently allowing the supervision of residents in teaching settings through audio/video real-time communications technology. The AMA supported allowing the virtual presence of teaching physicians during Medicare telehealth services and argued that this change should be made permanent. The AMA also supported permanently allowing residents to moonlight in the inpatient setting and permanently expanding the services that may be offered under the primary care exception.
• On July 2, the AMA commented on the proposal that would give residents greater flexibility to transfer to new hospitals during the winding down phases of hospitals. Overall, the AMA supported the new definition of “displaced resident” and asked that CMS make temporary cap increases effective retroactively to 2015 in the final rule. Moreover, the AMA urged CMS to work with the Accreditation Council for Graduate Medical Education to establish regulations that protect residents and fellows impacted by sudden program or hospital closure.
• On June 24, the AMA voiced support for the “Strengthening America’s Health Care Readiness Act” which would increase supplemental funding for the NHSC by $10 billion. This increased funding would be used for additional loan repayment and scholarship programs. Moreover, the bill contains a 40 percent set aside for historically underrepresented minorities in the health care field and provides mentoring and early recruitment for minorities. Additionally, the bill provides $50 million for a National Disaster Medical System (NDMS) piolet program which would bolster health emergency surge capacity.
• On June 2, the AMA endorsed the use of innovative models of clinical and educational work hour requirements and direct resident physician supervision via real-time interactive audio and video technology to optimize patient safety and competency-based learning opportunities during the COVID-19 pandemic. The AMA further supported the limits on direct supervision by interactive telecommunications technology to exclude high-risk, surgical, interventional, and other complex procedures including endoscopies and anesthesia. Moreover, the AMA supported the expansion of the primary care exception to include all levels of office and outpatient evaluation and management (E/M) codes.
• On May 11, the AMA sent a letter voicing our support for H.R. 6720, the “Student Loan Forgiveness for Frontline Health Workers Act,” and urging Congress to quickly pass this legislation. Physicians, residents, and medical students are playing a critical role in responding to the COVID-19 crisis and putting their health on the line caring for the sickest patients, many without appropriate personal protective equipment. As such, due to their selfless actions in the face of a national emergency, physicians, residents, and medical students who perform work to combat COVID-19 should be provided with meaningful relief in the form of student loan forgiveness.
• On April 30, CMS issued a second Interim Final Rule with comment period that gave providers additional regulatory flexibilities during the COVID-19 public health emergency. Among these regulatory changes are a few provisions that will be especially beneficial for GME students and residents during this time. Firstly, IME Payments will not be affected by the number of available beds in a hospital and the available bed count will be "considered to be the same as it was on the day before the emergency was declared." Additionally, CMS allowed teaching hospitals to claim the FTE time of residents at other hospitals on its Medicare hospital cost report during the declared emergency under certain circumstances. Moreover, teaching physician supervision rules changed and now the list of services that may be provided through the primary care exception have been expanded, and teaching physicians may "review the services provided with the resident, during or immediately after the visit, remotely through virtual means via audio/video real time communications technology." The AMA supported these provisions.
• On April 16, the AMA released a GME Resource Guide that addressed some of the benefits that were available for residents and medical students in 2020, ranging from loan relief to additional grants, to policies that helped make it easier to practice as a resident during the COVID-19 pandemic. The information in the resource guide also highlighted some of the helpful provisions that the AMA successfully advocated for in the “CARES Act” including the deferment of student loan payments and interest, increased volunteer liability protections, and federal work study flexibility.