Gov. Christie wants more doctors in New Jersey, and he's budgeted money to train them.
But increasing the number of medical professionals — and getting them to stay in New Jersey — isn't as easy as graduating more students. The calculation also includes the number of postgraduate residencies offered in New Jersey and the number of doctors who stay afterward.
The state already has increased the number of graduates, with Cooper Medical School of Rowan University opening in 2012 and Seton Hall University's medical school slated to open next year. Older schools also have added seats.
"The problem is, once you graduate medical school, you're only halfway done," said Thomas A. Cavalieri, the dean of Rowan University's School of Osteopathic Medicine.
Students need to finish their education with hospital residencies, which are in short supply.
"If you look five, 10 years down the road, there will not be enough residency opportunities for graduates of medical schools," he said, speaking of the national picture. "And we're trying to avoid a crisis. The crisis would be you get a medical degree, but you can't practice because there are no residency programs to train."
Nationally, there are already students each year who graduate from medical school and are not accepted into a residency program, leaving some to wait another year to try again or to give up and pursue another option, such as research.
"I have known other people who have tried three or four years in a row and didn't match," said Kelly Thibert, president of the American Medical Student Association, an advocacy group based in Virginia for medical students that has called for increased residency spots.
In his budget address last month, Christie proposed a $30 million increase to hospital-based training, the Graduate Medical Education program. The proposed increase would raise the total state funding to $218 million, 3.6 times the $60 million in aid the state distributed when Christie took office.
But the governor's proposal doesn't require hospitals to create more spots for medical residents; it subsidizes what hospitals already have. The $30 million reimburses hospitals for past expansion, not future growth.
From 2011 to 2015, the number of medical residents and fellows rose to 3,443, from 3,082. Hospitals offering residencies increased from 40 to 43.
The increased funding "will ensure that New Jersey residents have continued access to well-trained doctors and encourage those doctors to develop roots and make New Jersey their permanent homes," Christie said during the Feb. 28 budget address.
Residency programs are expensive, hospitals say, and they end up bleeding money — the New Jersey Hospital Association says teaching hospitals in the state will receive $613 million this year in federal and state subsidies for $1.28 billion in teaching costs, a reimbursement of about 48 cents for every dollar spent.
"You don't just start a program to get money," said John Slotman, vice president of graduate medical education policy at the nonprofit trade group. "You start a program and then somewhere down the line there's a chance, based on what the state is doing, there's a percentage of that that comes back to you."
Growing hospital residency and fellowship programs also is an important part of expanding the physician pipeline into New Jersey, experts say, as doctors often end up practicing in the region where they train as residents.
"It's a good recruiting tool. You train your residents, and hopefully they're going to stay in your hospital system," said Michael Geria, director of medical education at Inspira Health Network. "It's kind of like a three- or four-year job interview."
New Jersey already imports many of its residents, since it historically has had fewer medical students than residents. Expanding the state's medical schools could slowly increase the number of working physicians in the long run, but increasing the number of residency slots can help draw doctors, at the start of their careers, from other states.
"A lot of my mentors are also my colleagues now, which is kind of a weird situation, but it's kind of cool," said Brian Tran, who was an internal-medicine resident with AtlantiCare from 2013 to 2016 and was then hired as hospitalist and medical informaticist.
Tran, a California native, said he came to AtlantiCare with no ties to New Jersey. He has made a home in the state now.
After three years as a resident, Tran said, he had an understanding of the hospital's culture, systems, and the way things worked. That made the transition easy: "I know exactly who to call, I know my preferences of which consultant to consult, but I also know how to get things done, I know which case managers I have to talk to."
Dominic Zampino, program director of AtlantiCare Regional Medical Center's medical residency program, said the program makes a point of exposing students to the community around them.
"That's a big part of being a doctor, is knowing your population," Zampino said, citing volunteer work and outreach at local churches, senior centers, and schools.
Twelve to 14 residents enter and graduate from AtlantiCare each year, Zampino said, and last year, six were hired at the hospital.
For the hospitals, having residents also increases the standard of care, administrators said — in no small part because it requires everyone to be at the top of their game.
Physicians "have to stay on their toes because the residents are pushing them every day. And the residents are like little sponges; they want to pick up all the information, and the most recent information," said Geria, the medical education head at Inspira, which opened its residency program in 2011 and today has 146 trainees in Vineland.
Geria didn't hesitate when asked whether he hopes to expand Inspira's residency program.
"The country's in need of doctors. If we can grow, I would love to," he said.
He was similarly quick when asked what's stopping him.