AAMC Workforce Statement Looks at Supply, Demand

Suria Santana, ssantana@aamc.org

The AAMC Executive Council adopted at its June 2002 meeting a new set of physician workforce positions, reflecting the growing uncertainty as to whether the country faces an excess or a shortage of physicians.

While the AAMC’s previous workforce position statement was based on a projected physician surplus and recommended steps to reduce the aggregate physician supply, the latest statement acknowledges that the available data aren’t sufficient to clearly determine future supply and demand trends.

“Underlying the association’s old and new positions is how comfortable our organization is in projecting the need for physicians in this country,” says Robert Dickler, senior vice president in the AAMC’s Division of Health Care Affairs. “We discovered that we are less comfortable doing so today than we were 10 years ago.”

During the 1980s and 1990s, most workforce analysts and policymakers predicted that the country would experience an oversupply of physicians by the year 2000. Now that 2000 has passed, no conclusive evidence has surfaced indicating that physician supply is exceeding demand.

Anecdotal evidence indicates the opposite in some parts of the country, particularly in underserved rural areas and among certain racial and ethnic minority groups. The AAMC’s latest position statement on the physician workforce acknowledges the above, stating that cogent arguments may be advanced “to justify some increase in the enrollment of existing medical schools and/or the establishment of new medical schools” and graduate medical education programs.

“Some clear trends that have not changed are also reflected in our position statements,” explains Dickler. “Among them are the maldistribution of the physician workforce and its lack of diversity.” Reflecting the AAMC’s concern, the new position statement has an entire section dedicated to the issue of underserved populations, acknowledging that many “rural, urban, and underrepresented minority populations are likely to remain medically underserved for the foreseeable future.”

In response, the association proposes expanding opportunities for young doctors to work in underserved areas and in institutions treating disadvantaged populations. The AAMC’s commitment to more diversity in medical education is also highlighted in this section, which states that the “implementation of lawful, race and ethnicity-conscious decision-making in medical school admissions and in faculty recruitment and retention is essential” to meet the needs of an increasingly diverse society.

AAMC calls for trend analysis

Because it is difficult to draw strong conclusions from current data, the AAMC is calling for a thorough analysis of trends affecting physician supply and demand, the productivity of the physician workforce, and the rate of supply of physicians and other health professionals.

“We have concluded that there’s no good model for projecting the future need of physicians in relationship to the demands of the population,” says Michael Whitcomb, M.D., senior vice president in the AAMC’s division of medical education. “In predicting future physician supply, one needs to make a million assumptions, and working against making these assumptions is the fact that the nature of medical practice changes with time.”

The previous near-consensus in the health care community regarding the likelihood of an oversupply of physicians was based on different sets of research going back to the mid-1970s. In 1980, the Graduate Medical Education National Advisory Committee (GMENAC) predicted that the country would have an excess of approximately 145,000 physicians by 2000. However, GMENAC’s report wasn’t taken seriously because of perceived flaws in its mathematical modeling methods.

In the early 1990s, the research of several workforce analysts led to virtually the same conclusion. These analysts used physician staffing patterns of closed-panel HMOs as the basis for projecting demand for physicians, and argued that HMOs had an incentive to engage only the number of physicians required to meet the needs of enrolled populations.

Further, they presumed that HMO physician staffing could appropriately indicate the number of doctors required to meet the health care needs of the population. Studies showed that the number of physicians per 100,000 enrollees in closed-panel HMOs was far fewer than the number of M.D.’s per 100,000 individuals in the general population, so analysts concluded that the country would face a surplus of 150,000 physicians by 2000. Because this number wasn’t too far from GMENAC’s predicted oversupply of 145,000 physicians, most members of the health care community became convinced that these projections were accurate, after all.

Following these projections, many medical organizations, including the AAMC, issued position statements based on the assumption that the country was on the verge of a serious physician oversupply. “Previous projections didn’t incorporate questions of lifestyle changes, the possible consequences of demographic shifts such as the increasing number of women in the workforce, or differences between the new and old generations in terms of their attitude toward work,” says Dickler.

Attempting to address how the above trends, and others, impact physician supply, on Sept. 13 the AAMC will hold a collaborative meeting with the Milbank Memorial Fund of New York, a foundation that supports nonpartisan analysis, study, and research on significant issues in health policy. The meeting is one of many upcoming efforts on the part of the AAMC to tackle this complex issue.

“A vigorous effort should be undertaken to identify relevant trends and forces that impact either an excess or shortage of physicians in the future,” says AAMC President Jordan J. Cohen, M.D. “The AAMC intends to contribute substantially to the creation of this information and to its effective use for policy development.”

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