Graduate Medical Education That Meets the Nation's Health Needs (2014) / Chapter Skim
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2 Background on the Pipeline to the Physician Workforce
2 Background on the Pipeline to the Physician Workforce
Pages 35-60
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From page 35... ...
These include learning how to motivate young physicians to train in specialties and locate in areas where they are most needed; identifying ways to improve the diversity of the physician trainees to better mirror the overall population; increasing GME training in community settings; and ensuring that newly trained physicians possess the skills essential for everyday practice. Physician education has made significant progress since Flexner revealed the poor quality of medical schools in the early 20th century (Flexner, 1910)
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From page 36... ...
degree and are accredited by the Liaison Committee of Medical Education. Osteopathic medical schools confer the Doctor of Osteopathy (D.O.)
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From page 37... ...
NOTE: DO = doctor of osteopathy; EMR = electronic medical record; GME = graduate medical education; HIT = health information technology; IMG = international medical graduate; MD = medical doctor; NP = nurse practitioner; PA = physician assistant. SOURCE: Salsberg, 2009 (AAMC State of the Physician Workforce Address)
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From page 38... ...
According to the National Residency Matching Program (NRMP) ,3 about 3,500 new first-year Accreditation Council for Graduate Medical Education (ACGME)
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As Table 2-1 indicates, in the decade ending in 2012, overall enrollment in U.S. undergraduate medical colleges rose by nearly 28 percent, increasing from 80,180 to 102,498 students (AAMC, 2013a)
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From page 40... ...
medical school graduate applicants to graduate medical 16,874b 20,248c 3,374 20.0 education (GME) programs International medical graduate (IMG)
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From page 41... ...
. This section provides a brief review of trends in the number and type of GME programs and the available evidence on key characteristics of the physician trainee population and recent GME graduates -- by specialty and subspecialty, readiness to practice medicine in settings where most people seek health care, racial and ethnic diversity, and geographic location.
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From page 42... ...
Primary Care Training and Increasing Subspecialization in GME The makeup of specialties and subspecialties5 in the American physician workforce has changed dramatically since the advent of Medicare and Medicaid GME funding. In the early 1960s, primary care doctors made up an estimated half of the physician workforce (COGME, 2010)
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From page 43... ...
. The other IM subspecialties are adolescent medicine, critical care medicine, diabetes and metabolism, endocrinology, gastroenterology, geriatric medicine, hematology, hospice and palliative medicine, infectious disease, medical oncology, nephrology, pulmonary disease, rheumatology, sleep medicine, sports medicine, and transplant hepatology.
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From page 44... ...
SOURCES: ABIM, 2014; ABR, 2014; American Board of Anesthesiology, 2013; American Board of Emergency Medicine, 2014; American Board of Pediatrics, 2014; American Board of Psychiatry and Neurology, 2013; American Board of Surgery, 2014.
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From page 45... ...
Primary Care Physicians Many experts are concerned that the rapid transition to a highly specialized physician workforce has undermined the nation's capacity to progress to a higher-quality and less costly health care system. The corresponding evidence, however, is inconclusive (Baicker and Chandra, 2004; Chang et al., 2011; Detsky et al., 2012)
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From page 46... ...
A variety of workforce models suggests that innovative mixes of primary care personnel -- including greater use of APRNs, PAs, and team-based task delegation -- may reduce the demand for primary care physicians in the future (Altschuler et al., 2012; Auerbach et al., 2013a,b; Bodenheimer and Pham, 2010; Bodenheimer and Smith, 2013; Bodenheimer et al., 2009; Ghorob and Bodenheimer, 2012)
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From page 47... ...
program,7 established in the ACA, is one step toward expanding residency training in community settings. Unlike the Medicare program, which funnels GME funding through teaching hospitals to support residency training, the THCs receive GME funding for primary care residencies directly from the Health Services and Resources Administration (Chen et al., 2012)
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From page 48... ...
Diversity of the Physician Trainee Pool Producing a physician workforce that reflects the diversity of the American population has been a goal of medical schools, teaching hospitals, policy makers, and the health care professions for many years (AAMC and ASPH, 2012; COGME, 1998, 2005b; Grumbach and Mendoza, 2008; IOM, 2003a, 2004; Nivet and Berlin, 2013; Saha, 2014; Saha and Shipman, 2008)
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From page 49... ...
Despite the decades of efforts to address the problem, little is actually known about what works. Geographic Maldistribution Physicians -- whether primary care clinicians or subspecialists -- live and practice primarily in suburban and metropolitan areas.
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graduating from the state's residency programs and 66.6 percent of those who completed both undergraduate and graduate medical education in the state (AAMC, 2013a)
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Less than 3 percent of medical students expect to practice in a rural or small-town environment, where physician shortages are most acute. The United States is rapidly becoming one of the most racially and ethnically diverse nations in the world, but the gap between the diversity among physician trainees compared with the overall population is actually widening.
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2013a. 2013 state physician workforce data book.
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2009. Specialty and geographic distribution of the physician workforce -- what influences medical student and resident choices?
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2012. Teaching health centers: A new paradigm in graduate medical education.
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2012. Osteopathic physicians and international medical graduates in the rural primary care physician workforce.
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2012. Physician workforce projections in an era of health care reform.
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U.S. medical students learn 2014 national resident matching program in main residency match day results in ceremonies today.
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Commentary: Do medical schools have a responsibility to train physicians to meet the needs of the public? The case of persistent rural physician shortages.
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2009. Annual State of the Physician Workforce address.
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A look at the costs and benefits of operating graduate medical educa tion programs. http://www.rand.org/pubs/research_reports/RR324.
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