AAMC Reporter: June 2007

AAMC Holds Workforce Research Conference

Edward S. Salsberg, M.P.A., director of the AAMC Center for Workforce Studies (right) debates physician workforce questions with David Goodman, M.D., M.S., of the Dartmouth School of Medicine (left). Susan Dentzer of The NewsHour with Jim Lehrer moderates.

Leading national and international workforce experts convened May 2-4 for the AAMC's Physician Workforce Research Conference. This was the third annual conference convened by the association's Center for Workforce Studies to monitor, analyze, and advance research on the U.S. physician supply.

David Cutler, M.D., author of Your Money or Your Life: Strong Medicine for American's Health Care System, opened the conference with a keynote address on "The Changing Physician Marketplace," which examined the impact of information technology, the value of M.D.s, and "the supply side of health care" on the practice of medicine in the next decade.

"The practice of medicine will become more rewarding in the years to come," said Cutler. "Computers will enable doctors to cut paperwork in half and spend more time with patients."

The conference included a point-counterpoint discussion, "Physician Workforce Planning in a Broken Health Care System," between David C. Goodman, M.D., M.S., a professor of pediatrics and family medicine at Dartmouth Medical School, and Edward Salsberg, AAMC associate vice president and director of the Center for Workforce Studies. The debate focused on whether the nation needs more doctors for such reasons as shifting national demographics, or if changes in the nation's health care system can address the expected shortfall and prevent rising costs.

"Demand is clearly rising rapidly.We have large numbers of physicians who will be retiring and a new generation of physicians less interested in working long hours, and we have invested millions in interventions to improve the quality of life. That, to me, is a perfect storm type of scenario," Salsberg said. "We cannot produce enough physicians today to meet the needs of tomorrow."

"There are places that do well with a modest supply [of physicians]," Goodman responded. "There is no evidence that adding more physicians will lead to more benefit."

Conference attendees also explored the role of nonphysician health care professionals, new models of practice and training, and ways to streamline the business and practice of health care and medical education. Some of these explorations touched on the physician workforce as it exists across geographic boundaries. A presentation by Francis Omaswa, M.D., executive director of the Global Health Workforce Alliance, focused on the uneven international distribution of health care professionals caused by the emigration of qualified doctors out of developing regions for financial reasons.

Fitzhugh Mullan, M.D., Murdock Head professor of medicine and health policy at George Washington University School of Public Health and Health Services, said a global health service would allow physicians to work outside their home country, in areas where medical care and health care professionals are in short supply.

The final plenary session of the conference offered three perspectives on how generational differences among physicians may create tension in the workforce. Lois M. Nora, M.D., J.D., dean of the College of Medicine at Northeastern Ohio Universities, emphasized that while the baby boomer generation of doctors value a hierarchical workplace structure and trust their employers, their successors—Generation Xers—are more cynical and prone to question authority and value free time. Joseph Scopelliti, M.D., president and CEO of The Guthrie Clinic, a large multi-specialty practice, discussed how his organization is altering its recruitment and retention strategies to adapt to the changing workforce.

Clese Erikson, M.P. Aff., senior research associate at the Center for Workforce Studies, previewed two upcoming surveys by the AAMC and the American Medical Association that deal with physicians over and under age 50.Many of the findings echoed the prior presentations on generational differences. The younger generation clearly places strong emphasis on time for family and home life, Erikson said, but the findings show that as doctors approach retirement, their needs are not that different than those at the beginnings of their careers. Among surveyed physicians over 50, half said they would continue to practice beyond planned retirement if part-time work or more flexible hours were available.

In that vein, retired physicians who could be lured back into practice by less demanding workloads or other incentives could help assuage any shortage, according to Holly Mulvey, M.A., director of the multi-organizational Physician Reentry into the Workforce Project.

"There is a large shadow workforce of physicians who could be practicing in some capacity, but aren't," Mulvey said.

While some are returning to the workforce, obstacles such as tools for assessing competence and the high cost of retraining and recertification are preventing retirees from returning in larger numbers, Mulvey said.

In her closing remarks for the conference, AAMC Executive Vice President Carol A. Aschenbrener, M.D., emphasized the need for more dialogue and research. Aschenbrener also stressed that physicians should be adaptable to the demands of their junior colleagues and changing practice environment.

"Younger generation doctors want more time for family. We need to accept that," she said. Although physician maldistribution is a problem that has existed for decades, said Aschenbrener, innovative policies and ideas are essential to instigate change in the health care environment.

"We have to pay more attention to preparing a physician workforce that is flexible, adaptive, and expects change in their practice of medicine," she said. "To achieve this, we need to produce more data and engage in an ongoing dialogue in order to develop effective models for change in medical education and clinical practice."

—By Elissa Fuchs

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