Letter to Karen Nichols, Chair of the Accreditation Council for Graduate Medical Education - Senators Hassan and Braun Lead Bipartisan Push to Help Train More Doctors to Treat Opioid Use Disorder

Letter

Dear Dr. Karen Nichols,

Communities across the country are grappling with the devastating effects of widespread and growing substance misuse. More than 100,000 people died of a drug overdose in 2021 alone, while many others struggled with substance use disorders. Given the shortage of addiction specialists, access to treatment for these disorders depends on all medical providers, including internists, family physicians, obstetricians and gynecologists, pediatricians, and emergency physicians. Unfortunately, the Accreditation Council for Graduate Medical Education (ACGME) does not require residency programs in these fields to provide such training, and it has not announced plans to implement such a requirement for any of these specialties in 2022. The ACGME must swiftly update its specialty requirements to ensure that physicians-in-training gain the skills needed to address the current crisis.

The overdose crisis has persisted in part because of the dearth of treatment providers. Just one in five individuals with an opioid use disorder receives the treatment they need. As of 2019, fewer than seven percent of all physicians prescribe buprenorphine for an opioid use disorder.

ACGME has taken some steps to improve resident education on substance use disorder recognition, but experts believe the organization has not done enough to address the treatment of substance use disorders. While ACGME does not set curricula, it does create common program requirements that programs implement through their own curricular design. In 2018, ACGME directed all residency programs to "provide instruction and experience in pain management, if applicable for the specialty, including recognition of the signs of addiction."

Three years later, ACGME followed up with suggestions for how specialty residency programs could provide training for the treatment of substance use disorders. However, these recommendations were not binding, and the relevant programs have not put in place additional requirements.

Leading experts have recommended that residency programs be required to train physicians in addiction treatment. The National Academy of Medicine has published a perspective on making this recommendation, and a consensus committee of the National Academies of Sciences, Engineering and Medicine affirmed this conclusion as well.

The ACGME's general requirements are due for an update, and the specialty working groups update their requirements on an ongoing basis, meaning that there are opportunities for these updates to be issued in the near future. New requirements would align with the mission of the ACGME, which is "to improve health care and population health by assessing and enhancing the quality of resident and fellow physicians' education."

Given the urgency of this crisis, and the strong recommendations for residency programs to train physicians in treatment of substance use disorders, I am writing today to request additional information on ACGME's efforts. I ask that you respond to this letter by October 14, 2022 with answers to the following questions:

1. Are there currently enough addiction medicine physicians to treat all patients with substance use disorders?

2. If no policies change, when will there be a sufficient number of addiction medicine specialists offering treatment for substance use disorders to meet the existing need?

3. In the fields of internal medicine, family medicine, psychiatry, emergency medicine, obstetricians and gynecologists, and pediatrics, how many and what percentage of residency programs train all their residents in treating substance use disorders?

4. How many physicians were trained in residency programs last year to treat substance use disorders? How many will be trained this year?

5. How many physicians in residency programs receive a waiver from the Drug Enforcement Administration to prescribe buprenorphine as part of their training?

6. What is the position of ACGME on professional recommendations to require training in treatment of substance use disorders? With more than 100,000 Americans dying each year from fatal overdose, please explain why ACGME will or will not require such training in 2022.

I appreciate your response on this issue, and look forward to working with you to address this urgent matter.

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