AAMC Reporter: March 2006

Executive Council Considers Workforce Policy Changes

The AAMC Executive Council is considering several changes to the association's workforce policy. Recommended by the AAMC's Advisory Panel on Health Care Delivery, the proposed revisions were presented to the council at its February meeting.  The panel's key proposal calls for the AAMC to consider changing its recommended enrollment increase for LCME accredited schools from 15 percent to 30 percent over the 2002 levels by 2015. This would boost the number of graduates to about 20,000.

The panel also made recommendations related to international medical graduates (IMGs), including ongoing and stable funding to track contributions of IMGs to the health care community, requiring non-U.S. citizen graduates of foreign medical schools enter GME programs in the U.S. only on a J-1 educational visa, examining options for development of a formal voluntary process for assessing medical schools outside the U.S., and forming a mechanism for overseeing the clinical training experiences in the U.S. of medical school graduates enrolled in international medical education programs.

According to the panel's findings, an enrollment increase would directly address not only projected physician shortages but also growing international concern that English-speaking countries may be "draining" doctors away from less-developed countries. An increase in U.S. medical school graduates could help reduce the pull of physicians from other countries to the United States and may increase the United States' ability to provide physicians to areas of international need.

The recommendations come amid a steady growth in the number of osteopathic medical schools and graduates, of which there were more than 2,500 in 2003-2004, with a predicted spike to more than 3,500 by 2010-2011.

The Council on Graduate Medical Education (COGME), a national advisory body that makes policy recommendations regarding the adequacy of the supply and distribution of physicians, predicted in 2004 that if current trends in the health care workforce continue, demand for physicians will significantly outweigh supply by 2020.

The panel recommended the increase be accomplished by raising enrollment in existing medical schools and creating new medical schools, and proposed that the AAMC take a leadership role in assisting medical schools with enrollment expansion, including identifying and disseminating "best practices" for efficient and cost-effective medical education, promoting medical education innovations, evaluating alternative approaches to expanding school capacity, supporting students with MCAT scores and grade-point averages below those of current students, marketing medicine as a career, and expanding outreach to qualified students who currently do not apply to medical school, particularly among underrepresented minority populations.

Other recommended changes to the AAMC's workforce policy include:

• Expanding the number of graduate medical education (GME) positions to accommodate additional medical school graduates

• Continuing the AAMC's advocacy for increased medical school enrollment of underrepresented minorities

• Taking a more active role in supporting medical school associations around the world, especially in less-developed areas

• Increasing by at least 1,500 per year the number of federal National Health Service Corps awards to provide physicians for underserved populations and assuage rising medical student debt

• Using public and private funding to study relationships between physician preparation and the quality and outcomes of care.

These recommendations will be disseminated to AAMC members for feedback, with the goal of potential further action at the AAMC Executive Council's next meeting in June.

The Executive Council also approved the recommendations of the AAMC's Task Force on Clinical Research II. (The full task force report is temporarily embargoed pending possible publication in a peer-reviewed journal.) The task force was convened in 2004 in response to growing concern in the academic medical community over the difficulty in attracting young physicians to prepare for and enter careers in clinical research, the high attrition rate among accomplished clinical investigators within academic medical centers, and the perceived inadequacy of research environments to nurture and sustain investigators. This panel builds on the work of the AAMC's first Task Force on Clinical Research, created in 1998 to examine academic medical research environments and make recommendations directed at the training and career development of clinical investigators, clinical research infrastructure, the administration of clinical trials, and other factors.

In addition, the council held extensive discussions on an article in the Jan. 25 Journal of the American Medical Association, "Health Industry Practices That Create Conflicts of Interest," co-authored by AAMC President Jordan J. Cohen, M.D. After discussions, the council unanimously authorized the formation of a high-level task force to build on the previous work the association has done to provide guidance to our constituents on managing conflicts of interest. The task force will be charged to examine, especially, the current relationships that drug and device makers have with the educational mission of medical schools and teaching hospitals, and to bring forth recommendations for implementing safeguards to ensure continued public trust in our core missions. 

Another meeting highlight was a speech by Julie Gerberding, M.D., director of the Centers for Disease Control and Prevention (CDC), outlining potential future scenarios for the CDC and calling on academic medicine to work more closely with the CDC (including inviting faculty to spend sabbaticals at CDC facilities) and help educate the public on the need for a vital public health system.

"How many kids say, 'I want to be a doctor when I, grow up'?" Gerberding jokingly asked council members. "Now, how many kids say 'I want to be a public health official when I grow up'? That's something we want to change."

—By Scott Harris

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