COGME Report Predicts Physician Shortage

Unless medical schools expand student enrollment, the United States could soon face a shortage of physicians, according to a recently published report.

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, predicts that if current trends continue, demand for physicians will significantly outweigh supply by 2020. It recommends that medical schools expand the number of graduates by 3,000 per year by 2015.

The council’s report is a cautious first step to offset what is projected to be a major physician shortage in the future. By the council’s calculations, there will be an estimated 970,000 practicing physicians in 2020. Adding 30,000 new doctors would raise the 2020 figure to 1 million. The authors of the report acknowledge that the field will likely require a far greater increase and call for revisiting the issue again in five years.

“This report is a milestone that will have an impact on the nation’s physician supply,” said Edward Salsberg, director of the AAMC Center for Workforce Studies and lead author of the council’s report.

The report marks a significant reversal of the council’s earlier position articulated in reports published in the 1990s that the nation would be facing a surplus in the number of practicing physicians. It represents the council’s first call for increased enrollment in medical schools.

Although the recommended increase in enrollment is not expected to meet the projected increase in demand, improvements in productivity and changes in the healthcare delivery system might help achieve a balance.

To determine future supply, Salsberg traced the historical utilization of physicians and practice patterns to forecast supply and demand. The report accounts for societal trends that would impact the number and need for physicians. Among the trends considered were the aging of baby boomers – patients and doctors, overall population growth and current investments in new medical interventions that provide partial cures to ailments.

“Long range forecasting with on going monitoring and periodic reassessments is essential in this field because it takes 10 to 20 years to have an impact on the supply and specialty distribution of physicians,” he said. “But even with improved data and methods there are too many unknowns to be able to predict the long range with a high degree of confidence.”

In recognition of the uncertainty in forecasting supply and demand, the report recommends conducting additional research to guide decisions on the size and mix of the physician workforce. In addition, it recommends that specialty distribution be determined by marketplace demand, a shift in the council’s earlier position strongly recommending that 50 percent of new physicians practice in generalist specialties.

Increased School Capacity

Many medical schools have expressed their intent to increase student enrollment.

“I think a number of existing medical schools will respond to the COGME report with a modest increase in class size,” said Deborah Powell, M.D., dean of the University of Minnesota Medical School.

Dr. Powell’s institution will consider increasing its enrollment, she said, but the decision will only be made after considerable discussions with students and faculty.

Richard Krugman, M.D., dean at the University of Colorado School of Medicine, said that his institution considered increasing class size before the report came out.

“We had already planned to do this in part because of substantial state cuts in funding,” Dr. Krugman explained.

Another factor influencing the institution’s decision to increase class size is the fact that Colorado’s population has more than doubled since 1972, and demand for entrance to the medical school, the only one for 500 miles in any direction, has also increased. Despite the state’s population growth, the school’s enrollment of 132 has remained the same since 1972.

Colorado’s School of Medicine will increase its class size to 144 by no later than 2006, and the following year the figure will be increased to 160, according to Dr. Krugman.

Paul Roth, M.D., dean at the University of New Mexico School of Medicine, said that his institution would ask the state legislature to support the expansion of its class size from 75 students to 100.

Expressing support for the workforce study, Dr. Roth said that its observations and numbers have matched his institution’s own assessment of physician supply in New Mexico, a state that is “extremely rural and has its own particular nuances.”

Another issue worth considering in future workforce studies is the impact of other healthcare professionals on physician demand, Dr. Roth said. The increasing numbers of nurse practitioners, physician assistants and other licensed healthcare professionals might be having an impact.

Dr. Roth cautioned that statutory changes to residency slots financed by Medicare need to be addressed with this policy change. If medical schools follow the recommendation to increase enrollment to 3,000 a year until 2015, the number of students entering residencies would also increase, leading to figures in excess of the current graduate medical education (GME) caps. The report recommends the expansion of funding under Medicare for additional GME slots to accommodate the increase in U.S. medical graduates.

“Adding U.S. graduates will not cost teaching hospitals more money but will give them more choices among applicants for residency training and could therein improve the quality of residents.” Salsberg said.

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