AAMC Reporter: May 2008

Findings on Growing Enrollment Highlight Workforce Conference

Former U.S. Surgeon General David Satcher, M.D., Ph.D., delivers the keynote address at the fourth annual AAMC Physician Workforce Research Conference.

A new AAMC study released at the association's fourth annual Physician Workforce Research Conference estimates that the number of medical school entrants will increase by 21 percent by 2012, and that the nation is likely to meet the AAMC recommendation for a 30 percent increase in the nation's physician supply by as early as 2016.

The 2007 Medical School Enrollment Plans report, created by the AAMC Center for Workforce Studies, was one of the highlights of the conference, held April 30 to May 2 in Crystal City, Va. The conference brings together physician workforce researchers to share findings on topics including physician supply and demand, the health care system, and state- and specialty-specific data collection and analysis.

"This information is very encouraging and sends a signal to young people that there are growing opportunities to become a physician," Edward S. Salsberg, M.P.A., director of the AAMC Center for Workforce Studies, said of the enrollment report.

According to the report, the number of medical school entrants will increase by 3,400 or 21 percent by 2012 when compared to 2002 levels. Nine new medical school projects are in some stage of development or discussion, andmore than 86 percent of existing schools are expanding or planning to expand their enrollment. This progress signals a big step toward addressing the physician shortage, but another key component of medical education—residency training—also needs to grow, Salsberg said. Although graduatemedical education (GME) has slightly increased its capacity over the past decade, these programs may not be able to keep pace with medical school expansion without additional support—namely, increased funding or an adjustment to the federal cap limiting the number of residency positions at teaching hospitals.

"Will teaching hospitals...continue to grow residency positions with no government funding?" Salsberg asked. "In the absence of more GME growth, the physician supply will not increase."

Many physician workforce experts acknowledge the inevitability of a workforce shortage, but researchers from the influential Dartmouth Atlas Project have suggested that the main obstacle to health care access is not a shortfall in the total number of physicians, but rather a geographic imbalance in where physicians live and work (generally in affluent urban areas at the expense of rural regions) and inefficiencies in how they use their time when treating patients.

In a presentation at the conference, Richard A. Cooper, M.D., a senior fellow in the Leonard Davis Institute of Health Economics at the University of Pennsylvania, pointed out what he believes are methodological flaws in the Dartmouth research.He noted that the project's studies may have obfuscated important differences among geographic areas by dividing the country into overly large regions. In addition, Cooper raised concerns with Dartmouth's use of a region's Medicare expenditures, rather than its total health care expenditures, to compare variation in health care expenditures across geographic areas, and emphasized that this variation is largely driven by socioeconomic inequality.

"Poor individuals consume the most health care but have the poorest outcomes," Cooper said. "Instead of dismantling the health care infrastructure…the nation should strengthen its health care and social institutions and build a sufficient workforce of physicians to serve the public's needs."

Jonathan Skinner, Ph.D., John Sloan Dickey Third Century Professor in Economics at Dartmouth College, defended the Dartmouth studies, and repeated the project's claim that greater health care efficiency and more physician dispersion in underserved areas, and not an increase in physicians, are the keys to a better health care system.

"The more physicians that are treating people, the more trouble it is to coordinate care and realize the knowledge set of each physician," Skinner said.He recommended that the AAMC examine high-performing hospitals to determine some best practices in delivering efficient care. But as most experts now view a physician shortage in the U.S. as a fait accompli, the focus of the workforce debate is shifting toward the future landscape of health care itself, and how tomorrow's doctors will be trained and utilized. The physician workforce conference reflected that shift, as researchers discussed a range of strategies designed to ensure better health care access and quality.

"Increasing the physician supply is not the solution alone," Salsberg said. "Clearly that is one piece of the puzzle, but we have to think about what else the nation can do to improve the health care system."

The conference covered several innovative practice models, and whether they were likely to reduce demand for physicians.One of these models is the retail clinic, which features clear and predictable pricing and offers care provided by physician assistants and nurses.

"This is a promising extension of health care," said Dean Q. Lin, M.P.H., M.B.A., CEO of CareWorks Convenient Healthcare, the retail clinic arm of Geisinger Health System,which operates five retail clinics in Pennsylvania. "It would be a way to offset demand on emergency rooms and on physicians, especially on weekends or at night." In the conference's keynote address, former U.S. Surgeon General David Satcher, M.D., Ph.D., now director of the Morehouse School of Medicine's Center of Excellence on Health Disparities, told the crowd that the physician workforce was one means of improving health care quality and better serving all segments of the population.

"The gap between what we know and what we do is lethal," Satcher said. "People die every day in this country from lack of access... We want to be sure we have a system that responds to all the people, not just some of the people."

The physician workforce research conference was cosponsored by the AAMC and Harvard Medical School's Department of Continuing Education. The fifth annual Physician Workforce Research Conference will be held in spring 2009 in Washington, D.C. For more information and to download the 2007 Medical School Enrollment Plans report, go to www.aamc.org/workforce.

—By Elissa Fuchs and Scott Harris

Contact Us    © 1995-2009 AAMC    Terms and Conditions    Privacy Statement