Advocates for Evidence-Based Health Policy Speakers
The Physician Workforce
A recent Congressional hearing held by the Senate Finance committee explored the physician workforce. Extensive attention was paid to the role of primary care (internal medicine, pediatrics, and family medicine) in the overall medical field. The expert witnesses present seemed to support an expansion of the capacity for primary care practice. However, consensus suggested that expanding graduate medical education (GME) funding via Medicare would not be helpful.
Data published in the fall of 2008 obtained from the American Medical Association and the Association of American Medical Colleges demonstrates trends in the graduate medical resident population during the past decade. Since 1997, the Balanced Budget Act limited the expansion of Medicare-funded GME spots. However, from 2002 through 2007, 7754 additional residency spaces became available. Nearly half of these young doctors were graduates of American medical schools.
When looking at the distributional changes from 2002 through 2007, a noticeable decline in primary care training with an accompanying increase in subspecialty training occurred. There was a 2.8 percent decline in family medicine residents (- 273 persons). Young doctors instead chose fields such as anesthesia (+415 persons), emergency medicine (+633), neurology (+299), or radiology (+499). A major factor in these demographic shifts was an even more impressive proportional decline among graduates of American medical schools in primary care fields. Ffamily medicine had a 26.7 percent decline, internal medicine had a 7.5 percent decline, and pediatrics had a 1.8 percent decline.
Commentary:
America anticipates a relative shortage of physicians in the coming years, most notably in the field of primary care. A major driver of this phenomenon is the shift among young physicians from primary care fields to more lucrative medical specialties. Increasing American medical school graduates is unlikely to improve the numbers of primary care physicians without significant attempts to understand and reverse the reasons causing young physicians to avoid primary care.
by
Cedric K. Dark, MD, MPH