The Medical University of South Carolina and other teaching hospitals around the state need to figure out how to train more medical residents in rural areas without any more money.

The South Carolina Graduate Medical Education Advisory Group discussed its final recommendations during a meeting at the state Medicaid agency in Columbia on Friday. The group will suggest to the Legislature that 15 percent of the state's $185 million graduate medical education budget be set aside to encourage hospitals to produce more doctors in underserved parts of the state.

A draft report prepared by the advisory group indicates that South Carolina spends significantly more money than most other states to train doctors, but has too few of them in rural areas.

Teaching hospitals that receive Medicaid and Medicare payments to train medical residents will be required to address this shortage to continue receiving full funding.

"We'll be asked to do more with the same amount. To me, that means we're shifting around. That's hard to assess at this point," said Dr. Pat Cawley, executive director of the Medical University Hospital and a member of the advisory group.

While the advisory group's draft report calls for the hospitals to create more residency positions in rural South Carolina, the state government is not willing to give them any more money to do that.

"Our position is . there is sufficient money to pay for the slots that we have," said Deidra Singleton, deputy director of the South Carolina Department of Health and Human Services.

There's also enough money to create new positions, she said.

Cawley, who attended the meeting in Columbia on Friday on behalf of MUSC, stressed to the group that although the state may be unwilling to spend more on graduate medical education, South Carolina should consider accepting more federal money, if it becomes available.

"Pulling down additional dollars for more slots, if possible, is vital," Cawley said. "There are states - Georgia, North Carolina, New Jersey - that have recognized that we're going to have a doctor problem because of health care reform and they're putting more slots in - some federal, some state."

MUSC received more money than any other teaching hospital in South Carolina - about $141 million during the last fiscal year - from the state Medicaid agency and the federal Medicare program to help pay for medical residency positions and the physicians who train those new doctors.

Eleven teaching hospitals in South Carolina received a combined $185 million from the state Medicaid agency last fiscal year to fund graduate medical education and supplemental teaching payments. This does not include additional money from the federal Medicare agency that each of these hospitals also received to fund residencies.

The advisory group will send its final report to the General Assembly for review in mid-January.