In a significant step toward alleviating the nation’s growing physician shortage, CMS announced in December the distribution of 400 new federally funded graduate medical education (GME) residency positions to hospitals across the country. This move, which largely supports training in primary care fields like internal medicine, builds on congressional efforts to expand the physician workforce after decades of funding limitations.
For allergists and immunologists, understanding the politics behind this is key: GME refers to the hands-on residency training programs that doctors complete after medical school, which are essential for becoming licensed specialists. Medicare provides much of the funding for these programs at teaching hospitals, but federal support has been capped since 1997, creating a bottleneck that has limited the number of new doctors entering the field each year. This cap has contributed to projected shortages across nearly all medical specialties, including allergy/immunology, where demand for experts in managing conditions like asthma, food allergies, and immune disorders continues to rise.
A 2021 editorial in the Annals of Allergy, Asthma & Immunology by Alnoor Malick, MD, and J. Allen Meadows, MD, highlighted the ongoing crisis in our specialty. Nearly 15 years earlier, an ACAAI White Paper had projected that the number of full-time equivalent allergist/immunologists would steadily decline from 2006 to 2020, while demand was expected to surge. These warnings underscored the need for expanded training opportunities to prevent worsening access issues for patients.
According to projections from the Association of American Medical Colleges (AAMC), the U.S. could face a shortfall of up to 86,000 physicians by 2036, with shortages affecting medical specialties like allergy/immunology. Federal data extends this concern to 2038, estimating a potential gap of more than 140,000 full-time physicians in 30 out of 35 specialties. These shortages hit rural and underserved areas hardest, where access to specialized care for allergic and immunologic diseases is already limited.
Congress began addressing this in 2021 with the Consolidated Appropriations Act (CAA), which authorized 1,000 new Medicare-funded slots to be distributed over five years, followed by an additional 200 slots in the 2023 CAA. With this latest round – the fourth under the 2021 law and the first under the 2023 expansion – more than half of the total 1,200 authorized positions have now been awarded to 135 hospitals in 37 states. While the focus is on primary care, this overall increase in training opportunities helps build a stronger pipeline for subspecialties like allergy/immunology with increased residencies in internal medicine.
The College has long championed increased GME funding as a top advocacy priority to grow the workforce and improve patient access to care. To that end, ACAAI Immediate Past President James Tracy, DO, initiated Pathways to Practice (P2P): Advancing Excellence One Fellow at a Time, which directly supports the training of 16 new allergy/immunology fellows through four competitive $250,000 (two-year) grants awarded each year, with fellowship positions beginning in 2026.
For years, the College has pushed for expansions in federal support, including recommendations to add thousands of new slots over the coming decade and specific calls to boost training in underserved areas through programs like the Teaching Health Center GME. ACAAI supports this latest action by CMS and applauds it as meaningful progress toward addressing the physician shortage that impacts our specialty and patients nationwide.
As AAMC Chief Health Care Officer Jonathan Jaffery noted, “Academic health systems are already incurring a significant financial burden by choosing to train a portion of their medical residents without federal support. This new round of residency positions will allow them to continue investing in physician training to the benefit of patients nationwide.”
This development underscores the importance of ongoing advocacy. ACAAI will continue to monitor and push for further GME expansions to ensure the allergy/immunology workforce can meet future demands. For more of our advocacy efforts, visit the ACAAI Advocacy Council resources page.
The Advocacy Council – ADVOCATING FOR ALLERGISTS AND THEIR PATIENTS.
