Letter to the Editor — Need for Increased Funding for Residency and Fellowship Programs

From time to time, we receive letters to the editors on a story.  Today we received this well writing letter from Natalie Bullock, Doctor of Occupational Therapy Student, University of Pittsburgh Class of 2024 on an older article that still remains relevant to today’s expanded need for additional healthcare professionals.

I would like to address the following article: “Federal budget cuts and teaching
hospitals,” (May 6, 2018, Policy and Medicine: A Rockpointe Publication). The article went in
depth about a 2018 congressional proposal that could cut over, “$60 billion in Medicare
payments for graduate medical education at our nation’s teaching hospitals,” and could
negatively impact patient care and the future of medicine. Additionally, the article touched on
how there is already a shortage of doctors in the U.S. and this budget cut will increase this
deficit. As mentioned in the article, this is an immense problem in general but will become an
even larger problem due to our aging population. Also, the article explained how teaching
hospitals are essential for training the next generation of doctors that will be able to provide care
to Americans for the rest of their lives. In other words, teaching hospitals are an investment in all
of our futures.

In December 2021, the Centers for Medicare and Medicaid (CMS) increased funding for
1,000 new residency programs in rural and underserved communities (Centers for Medicare and
Medicaid, 2021). This is good news, but this increase in funding is not enough. The funding will
run out eventually and we will be back in the same position as we were before: in a shortage of
health care professionals and available medical services. This will only become a larger problem
as the need for medical care and rehabilitation increases during the COVID-19 pandemic.
I am an occupational therapy doctoral (OTD) student at the University of Pittsburgh, and
I believe that the continued lack of funding for teaching hospitals and medical education will not
only affect doctors and their patients, but also occupational therapists and our patients as well as
occupational therapy students. First of all, the article mentioned how UPMC Presbyterian
Hospital in Pittsburgh would be one of the hospitals most impacted by budget cuts and this is
where many of us OTD students go for our fieldwork education experience. Fieldwork education
is where we receive our hands-on training and experience as future occupational therapists. We
are not paid for our fieldwork experience, however, if licensed occupational therapists lost their
jobs at this hospital it would impact the number of students that are able to attend fieldwork at
this site and care for patients. Lack of funding could also impact other hospitals in Pittsburgh as
well which further decreases the opportunities we have to participate in fieldwork. In other
words, this would negatively impact my ability as a student to deliver occupational therapy
services. Additionally, if the shortage of doctors worsens, there will be less doctors to refer
patients to occupational therapy and less doctors to work on teams with occupational therapists
to deliver care. And with the pandemic continuing to rage on, this is likely to occur. Thus, this
would also negatively affect my ability to deliver occupational therapy services because this
could impact the number of patients a team of medical professionals, including occupational
therapists, are able to see. Furthermore, this will limit the population’s ability to access
occupational therapy services because they will be limited in the amount of medical care they
will be able to receive in general because of the lack of doctors and health care professionals,
including occupational therapists.

In conclusion, I agree with the author that the previous congressional legislation to cut
the budgets, as well as the continued lack of funding, of teaching hospitals will negatively impact
the future of medical care and the patient experience. I think it is also important to keep in mind
how a continued lack of funding will cause even bigger issues down the road because of our
aging population and due to the aftermath of the pandemic. Additionally, I think it is important to
recognize that lack of funding not only impacts physicians, but it also impacts other medical
professionals like occupational therapists. This is because we are all connected and dependent on
each other in this field. We provide the best patient care when we collaborate. Therefore, I hope
that politicians who craft and vote on future legislation continue to view health care professionals
as essential and see our need for continued funding because I believe we are the key to a bright
and healthy future.
Sincerely,

Natalie Bullock