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a generation. The numbers of new grad uates, per se, aren’t the issue. “During the last 20 years, there has been a dramatic increase in the number of medical school graduates due to new and expanding allopathic and osteopathic medical schools,” Simari says. “That means approximately a 30 percent incre ase in the number of medical-school grad uates.” The challenge, he says, is what comes after. “Graduate medical education, or residencies, have not increased at the same rate, so the gridlock is the number of doctors able to be trained in a resi dency,” Simari says. “While legislation has been brought forward at a national level, there have been no major changes in how residency slots are funded or developed in the last few decades.” Like KCU, the KU school has looked across the state for redress. “During the last 15 years, we have increased class sizes as well as added a four-year campus in Salina and expanded our campus inWichita from a two- to four year campus,” Simari says. “Considering

“The gridlock is the number of doctors able to be trained in a residency. ... There have been no major changes in how residency slots are funded or devel oped in the last few decades.”

— ROBERT SIMARI, VICE CHANCELLOR UNIVERSITY OF KANSAS SCHOOL OF MEDICINE

whether to expand further is a complex decision that also hinges on available clinical learning environments. Our cur- rent clinical learning environment inc- ludes students from UMKC and KCU, so any solution needs to take into consider ation the number of clinical learners.” On the policy end, Huenergardt also lasers in on the need to streamline licensure and credentialing in all states: “If you’re licensed in one, make it easier to use your license in a neighboring state,” he says. Beyond that, “we also have work to do on our visa process and legal immigration system. We have nurses here now who can’t get visas extended or work authorization renewed, andnurses inother

countries who want to come here, but the system is incredibly slow to get them in place.” None of this, executives say, should suggest that this is a matter for the health care and medical-education complexes to resolve on their own. “Communities and health-care sys- tems also share the responsibility to recruit physicians,” Simari says. “Physic- ians who are finishing their residencies have options as to where they will go to practice. It is up to the hospital, community, city, or region to make it attractive for the physician to practice there.”

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