AAMC Reporter: July 2006

AAMC Executive Council Approves Workforce Policy, Honors Dr. Cohen

Outgoing AAMC President Jordan J. Cohen, M.D., with the association's new president, Darrell G. Kirch, M.D., in front of Dr. Cohen's portrait by artist Steven Polson

Several key initiatives were approved by the AAMC Executive Council at its June meeting. The association governance endorsed a new workforce policy calling for an increase of 30 percent in medical school enrollment, advised the AAMC to move forward on implementing a national service to conduct criminal background checks, and established an association task force to examine the current relationships between the medical education community and industry.

The council also honored outgoing AAMC President Jordan J. Cohen, M.D., at a Washington reception. During the event, Dr. Cohen's portrait by artist Steven Polson was unveiled. The painting will be displayed at the AAMC's headquarters along with the portraits of the association's two other former presidents.

"Jordan has truly been a remarkable leader," said Thomas M. Priselac, M.P.H., AAMC chair and president and chief executive officer of Cedars-Sinai Health System. "With his vision and values, he has really challenged the field. But while he's fostered change, he has also allowed us to hold fast to those values that make us great."

Darrell G. Kirch, M.D., officially assumed the role of AAMC president July 1.

But even amid the goodbyes, attendees, including Cohen, remained focused on the wide-ranging business agenda at hand. Chief among the items was the recommendation that enrollment in U.S. medical schools be increased 30 percent by 2015. As evidence of a national physician short-age grows, the expansion would result in an additional 5,000 new M.D. students annually and should be accomplished by boosting enrollment at existing schools, as well as by creating new medical schools.

"A shortage of U.S. doctors would have a profound impact on all Americans by affecting access to quality health care, especially for the underserved, who already encounter substantial barriers when seeking care," Cohen said. "Based on current evidence, we believe this recommended increase will help prevent a future shortfall and meet the health needs of our nation." Cohen added: "Given the extended time it takes to educate and train tomorrow's doctors, efforts to increase enrollment must get underway as soon as possible to assure that the health care needs of the nation in 2015 and beyond are met."

In February 2005, the AAMC recommended a 15 percent increase in U.S. medical enrollment. Subsequent analysis of significant factors that affect physician supply and demand by the AAMC's Center for Workforce Studies found that a 30 percent increase was warranted. These factors include projected increases in U.S. population, an aging physician workforce and general population, Americans' rising expectations for effective health care, and a new generation of physicians who may choose to work somewhat less than their predecessors.

In another key vote, the Executive Council approved the recommendations of the AAMC Criminal Background Check Advisory Committee and directed the association to develop appropriate business and implementation plans for a national centralized system for conducting checks on accepted medical school applicants. The service, which will be administered by the AAMC, would initiate a check at the time of the first acceptance of an applicant by a participating medical school, with the information then available to other participating schools who accept the applicant.    

Robert F. Jones, Ph.D., senior vice president of the AAMC's Division of Medical School Services and Studies, which would be responsible for the service, acknowledged that several questions remain to be addressed, including where the data would be stored and how they would be disseminated to each school. He said the association would have a clearer picture of the system after identifying an appropriate company to conduct the checks and would keep the governance informed as plans develop.

"We will immediately begin to prepare a request for proposal by vendors," Jones said. "While the checks would be comprehensive, each participating school would determine the types of information provided to them, in accordance with their institutional policies and state laws."

Jones said it will probably take two years to create and test the background-checks system before fully implementing it. Once the system is up and running, the cost is estimated to be approximately $1.5 million annually. Jones said it was uncertain how the system will be funded. If the cost could not be absorbed by existing revenues, options to be considered by the AAMC governance would include increasing fees for applicants, implementing a subscription fee for participating schools, or raising dues. It is hoped that some of these costs could be absorbed. "By centralizing, we are preventing applicants from having to pay for multiple checks, but still we're sensitive to putting any more cost burdens on students than we have to," Jones said.

Also during the meeting, the Executive Council voted to establish a task force to address conflicts of interest that may arise with industry support of medical education.

"I think we're all acutely aware there has been growing industry involvement in medical education," Cohen said. "I think our culture presently is one where there's a lot of dependence on the financial support derived from industries…marketing does affect decision making in ways often at variance with patients' best interests…I think it is a topic we have to take extraordinarily seriously."

The task force will be charged with defining the opportunities and pitfalls in research-industry relationships; establishing guiding principles for the relationships; reviewing current policies and procedures at medical schools and teaching hospitals that regulate industry influence on educational activities; identifying best practices in these areas; recommending policies that respect the value of the academic-industry partnership and safeguard evidence-based decision-making and educational content offerings; suggesting strategies, timelines, and benchmarks for implementing recommended changes; and creating a scope for the implementation and establishment of an ongoing advisory committee on the subject.

— By Scott Harris

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