AAMC Reporter: June 2006

AAMC Holds Second Physician Workforce Conference

Almost all attendees at the AAMC's second Physician Workforce Research Conference agreed on a common problem: If current trends hold, a serious physician shortage is all but inevitable.

Finding a workable solution, however, is not so simple.

But there were plenty of ideas on the table at the conference, jointly sponsored by the AAMC's Center for Workforce Studies and the Harvard Medical School Department of Continuing Education. Dialogue touched on areas including the educational pipeline, legislation, technology, and globalization.

Several studies over the past few years have predicted serious physician shortages within two decades or sooner, potentially crippling the nation's—or the world's—health care system. The AAMC's current policy is a 15 percent increase in medical school enrollment, with a vote to recommend a 30 percent increase scheduled for the AAMC Executive Council meeting late this month.

In remarks to conference attendees, AAMC President Jordan J. Cohen, M.D., said the shortage will necessitate innovative approaches.

"As we look at increasing our capacity at medical schools and the enormous costs that go along with it, we think about reproducing the models of education that we've grown accustomed to," Cohen said. "But we should find less expensive models for training doctors. Of course, we still want nothing less than the best students and training, so the question becomes, what can we learn from other models?"

Among the models explored during the conference were those of community-based or regional medical campuses and the growth of osteopathic medicine. The conference also heard from representatives of Tulane and Louisiana State universities on the innovations they put in place in response to Hurricane Katrina. Cohen said another model could be found in a performance-based educational system.

"Perhaps a four-year school could be replaced by one where students reach a certain level of competence," he said. "It's more complex, but it might be worth investigating."

Fitzhugh Mullan, M.D., Murdock head professor of medicine and health policy at George Washington University, called for a retooling of the federal Health Resources and Services Administration's Title VII programs, which historically have provided support for health professions training and education. President Bush proposed a virtual elimination of Title VII as currently constituted in his fiscal year 2007 budget.

"We need new legislation here," Mullan said, "to stimulate new medical school growth and reach down the educational continuum into high schools in order to further education."

Mullan specifically called for increased collaboration between government and academic medicine, a new federal institution dedicated solely to primary care issues, and more funding for medical schools, Community Health Centers, and the National Health Service Corps, among other recommendations. In the meantime, other solutions were suggested that would decrease the current demand for physician services today, including strategies to improve productivity and efficiency, such as increased reliance on physician assistants and nurse practitioners and expanded use of information technology.

For example, Mary D. Naylor, Ph.D., F.A.A.N., R.N., Marian S. Ware professor in gerontology at the University of Pennsylvania, said more responsibility should be delegated to nurse practitioners, physician assistants, and similar professionals.

"The evidence supporting nurse-doctor collaborations is compelling," Naylor said. "Proven models of care here should inform workforce projections. Nurse practitioner involvement greatly improves patients' adherence to guidelines and substantially reduces readmission rates."

Naylor was one of the participants in a round-table discussion on the future of primary care, which was moderated by Susan Dentzer, health correspondent with PBS NewsHour. Panelists agreed that primary care practitioners and advocates have their work cut out for them in coming years and that assuring access to primary care services rather than only to primary care physicians should be a key component of future strategies.

Conference attendees also expressed optimism over the increasing role of medical technology. Special Web sites for patients with chronic illnesses, electronic medical records and specialist consultations, increased doctor-patient e-mail, and other tools—along with compensation structures that pay doctors for their time using such technologies—were all mechanisms that some predicted could help physicians do more in less time.

"Information technology will be absolutely key," said Philip Madvig, M.D., associate executive director of the Permanente Medical Group. "We have to move away from the face-to-face encounter between a doctor and a patient…But people have to be paid for doing work that is not presently billable. Electronically based care is not now widely compensable, and doing so would foster more integration of these technologies."

Any tool that decreases the need for in-person encounters is particularly important, some conference speakers argued, because the issue of a workforce shortage is a worldwide problem.

"Workforce analyses that doesn't encompass global trends are going to be significantly compromised," said Timothy Evans, Ph.D., assistant director-general of the World Health Organization (WHO). "Global solidarity is important here."

In April, the WHO issued "Working Together for Health," a report focusing on global health workforce shortages, especially among less developed countries. According to Evans, 36 African countries collectively lack approximately 800,000 physicians and other health care workers, while the United States gets approximately 25 percent of its physicians from foreign countries. Evans called for international migration agreements, more ethical physician recruitment practices, and incentives to practice in one's home country.

Participants agreed to keep looking at all possible options.

"The bottom line is that there is no bottom line," said David Blumenthal, M.D., director of the Institute of Health Policy at Massachusetts General Hospital/Partners Health Care System. "The demand for healers as a class is eternal and certain. But the size and composition of the demand is eternally uncertain."  

"We're facing some very difficult challenges," said Edward S. Salsberg, M.P.A., director of the AAMC Center for Workforce Studies. "If we do not act soon to address physician workforce issues, we will be doing a disservice to our nation."

Conference presentations are available at http://www.aamc.org/workforce

— By Scott Harris

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