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SUMMARY
Pages 1-14

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From page 1...
... This fact notwithstanding, the Institute of Medicine (IOM) concluded that a brief review of data on aggregate supply and requirements and an examination of options for dealing with the physician workforce would be a valuable-and more timely contribution in the current policy environment.
From page 2...
... First, the nation should not tie national workforce policy or graduate medical education to the service delivery needs of selected parts of the health care system. Second, long-term physician workforce policy should be driven by aggregate requirements nationally, and meeting those requirements should be cued more to the output of U.S.
From page 3...
... medical graduates (USMGs) in GME training has remained stable since the early 1980s, but between 1988 and 1993, the number of IMGs in residency or fellowship training increased by 80 percent (from 12,433 to 22,7069; the number of IMGs in first-year residency positions grew by more than 3,200 between 1988 and 1993, whereas the number of USMGs declined by nearly 230 individuals.
From page 4...
... As elaborated in Chapter 3 of the text, the committee's review of data and published materials, discussions with physician workforce experts at its July meeting, and further deliberations led it to conclude that an oversupply of physicians in this country poses more problems for than solutions to the nation's health care issues. Taken as a whole, the literature on empirical inquiries into the relationship between the overall supply of physicians (on the one hand)
From page 5...
... . s Having far more physicians than needed to meet the nation's requirements is a waste of the federal resources currently spent on physician graduate education, and it may also be a poor personal investment on the part of prospective medical students.
From page 6...
... It opted for a steady-state approach to undergraduate medical education. Specifically, the committee recommends that no new schools of allopathic or osteopathic medicine be opened, that class sizes in existing schools not be increased, and that public funds not be made available to open new schools or expand class size.
From page 7...
... In keeping with the principles stated earlier and the- committee's concerns about the growing number and proportion of IMGs in the nation's physician supply, the committee recommends that the federal government reform policies relating to the funding of graduate medical education, with the aim of bringing support for the total number of first-year residency slots much closer to the current number of graduates of U.S. medical schools.
From page 8...
... have an interest in continuing to provide graduate training experiences for foreign medical graduates. Such training brings individuals of many cultures and backgrounds together in ways that can have major beneficial effects on international understanding, communication, and cooperation (although the committee notes that the residency training that IMGs now receive here can be inappropriate preparation for the kinds of health care challenges they may face upon returning home)
From page 9...
... Rather, the committee wished to go on record as favoring limitations in the use of IMGs in graduate training as a means of solving service-delivery problems and, at the same time, as urging policymakers and health professionals to take responsible steps to ensure that poor and other populations now served chiefly by IMGdependent hospitals are not harmed. In regard to this later point, the committee acknowledged the broader issues of access to health care for all and took note of the view of an earlier IOM committee, which had identified making basic health care coverage universal as a fundamental goal of health care reform.
From page 10...
... The committee further recommends that the American Medical Association, the American Association of American Medical Colleges, the American Osteopathic Association, the American Association of Colleges of Osteopathic Medicine, and other professional associations cooperate with the federal government in widely disseminating such information to students indicating an interest in careers in medicine. Needed are data on: the current size and composition of the physician workforce and future projections of supply and requirements; specialty and practice location choices; other parts of the workforce, particularly training and employment of personnel that are likely to be substituted for physicians in managed care organizations or hospitals; and the complex interactions of physician supply with health care costs access, and quality.
From page 11...
... The nation's major health foundations also can support the types of physician workforce research envisioned above, particularly those with long interest in issues related to the health professions, for example, the Pew Charitable Trusts, the Robert Wood Johnson Foundation, and the Josiah Macy, Jr., Foundation
From page 12...
... health care system; technological breakthroughs and the shifting balance between halfway technologies and the definitive interventions that will prevent or cure disease; the changes that may occur in the production of U.S. medical graduates; changes in the financing for graduate medical education; shifts in the rate of immigration and entry into practice of foreign medical graduates; and developments in the use of nonphysician health personnel.
From page 13...
... 7j in the meantime, the report points the w~ to decisive actions that aN interested ponies in both the public and private sectors can usefully take now to forestay even more significant di~culdes in the future. 1111111111111111111111~14~1~1111111111 111111111111111111111111~1111111 1 nl~i~/lllllll~llll~#ci~llllll~ml-(lllllll~mm~slllllllth~lllllllllll


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