Developing the Workforce

AAMC Initiatives Center for Workforce Studies Created to help promote a physician supply and distribution by specialty and by geographical area consistent with demands and needs of the U.S. population. AspiringDocs.org This campaign and Web site raises awareness about the need for more diversity in medicine and encourages African American, Latino/a, and Native American students to apply to and enroll in medical school. Summer Medical and Dental Education Program (SMDEP) This free summer academic enrichment program is for freshman and sophomore college students who are interested in a career in medicine or dentistry.

The predicted future shortage of physicians, as well as nursing, pharmacy, dental, and other medical professionals, has been well documented. Without a workforce expansion, access problems for all—but especially for those in underserved communities—will be exacerbated.

Serious efforts must be made to expand the number of health professionals educated to care for a population that continues to grow and whose aging will place unprecedented demands upon the health care system. The costs of educating and training physicians, in particular, are exceptionally high compared to the costs of other professions because of the extensive duration of physician education and the need for education in a clinical environment.

And just as the health care delivery and financing systems must identify ways to improve efficiency and quality, academic medicine must also assess the educational process to determine whether it can become more efficient, while maintaining and improving the goals of achieving a high-quality physician workforce that both reflects the population and meets its health care needs. Changes in the delivery system will affect how clinical education is conducted, and the education process must reflect this.

The costs of physician education and training have traditionally been borne by a complex variety of sources, particularly the trainees, the medical schools and teaching hospitals that train them, and the government. As the system is transformed, these costs will continue and may even rise as adjustments are made to the content of the education, sites of education, number of students, and the expanding scope of knowledge. Given the impending physician shortages, it will be important to identify stable funding sources that will expand and build upon existing mechanisms.

We must also address the geographic disparity of providers. Health care professionals are virtually absent in some communities; nearly 30 million people live in federally designated underserved communities. While improved access may be facilitated by coverage for all, coverage alone will not ensure access. The nation must work to develop policies that create appropriate, effective incentives for health providers-whether nurses or generalist or specialist physicians-to locate in communities of need supported by services such as telemedicine, regional health networks, and other innovations.

Finally, the health care workforce should reflect the underlying diversity of the nation and support continued improvement in health status across diverse communities. This will require attention not only to geographic disparities but also to ethnic disparities, the needed mix and location of primary and specialty providers, and to the relationships between providers and the patients and communities they serve.

Learn More About Developing the Workforce

The Physician Shortage and Health Care Reform (PDF)

Why is There a Shortage of Primary Care Doctors? (PDF)

The Resident Physician Shortage Reduction Act of 2009 Summary (PDF)

Related Correspondence

AAMC Comments on Tri-Committee House Health Care Reform Discussion Draft (PDF) July 3, 2009

Letter to Congress from the AAMC's Council of Deans and the Council of Teaching Hospitals (PDF) July 2, 2009

AAMC Support and Thank You Letter for the "Resident Physician Shortage Reduction Act of 2009" (PDF) May 5, 2009

Graduate Medical Education (GME)

In addition to providing basic health services to their communities, teaching hospitals are also sites for the clinical education of all types of health professionals, including the training of resident physicians ("residents"). Residents have graduated from a medical school and then go on to complete several years of supervised, hands-on training in a particular area of expertise, such as primary care or surgery. This phase of their training is called graduate medical education (GME).

Teaching hospitals also maintain an environment in which clinical research can flourish, and assure all patients have access to highly specialized care, regardless of their ability to pay. Because of their education and research missions, teaching hospitals offer the newest and most advanced services and equipment. Additionally, the residents and supervising physicians at teaching hospitals are available around-the-clock, prepared to care for the nation's most critically ill or injured patients. These unique teaching hospital missions increase the cost of patient care at these institutions.

The Medicare program makes explicit payments to teaching hospitals for a portion of these added costs through Medicare Direct Graduate Medical Education (DGME) Payments. Recognizing the differences in the patient care costs between teaching and non-teaching hospitals, the Medicare program includes a special Medicare Indirect Medical Education (IME) Payments adjustment in its prospective payment system (PPS).

On April 22, 2009, the AAMC partnered with the American Osteopathic Association (AOA) to present a Capitol Hill briefing on Medicare support for graduate medical education, particularly in the context of health reform. As Congress continues its work on health care reform legislation that improves access for all Americans, we must continue to train a health care workforce that meets the needs of all communities. Medicare is a vital component of support for GME, the post-medical school training which prepares doctors for practice in their specialty or sub-specialty.

Learn More About GME

Graduate Medical Education (PDF)

Graduate Medical Education: The Basics (PDF)

Overview: Graduate Medical Education and Health Care Reform—Reporter, July 2009

Medicare Direct Graduate Medical Education (DGME) Payments (PDF)

Medicare Indirect Medical Education (IME) Payments (PDF)

In the Media

Primary Care Doctors—The Diane Rehm Show, NPR/WAMU, July 2009

Heart Surgeon Shortage Predicted—U.S. News & World Report, July 2009

U.S. Teaching Hospitals Need Federal Support—Roll Call, Op-Ed by Atul Grover June 2009