Facing persistent reports of shortages in some specialties, the AMA is reconsidering its longstanding position that there is a physician surplus and that residency training positions should be cut.
"The predicted oversupply has not materialized," said David Wilson, M.D., who chairs an AMA subcommittee charged with drafting an update of AMA policy.
At a hearing today, Wilson's subcommittee of the AMA Council on Medical Education asked for input for proposed policy changes on physician supply that it will deliver to the AMA interim meeting in December.
According to the subcommittee's summary, current AMA policy states that "there currently is, or soon will be, a surplus of physicians in many regions and specialties" and "there is a need to increase the availability of primary care physicians."
The policy was developed in the 1980s and 1990s in reaction to the growth of HMOs, which were supposed to deploy doctors more efficiently and increase demand for primary care physicians, Wilson and others explained.
But policymakers failed to take other trends into account, says William Owens, M.D., an anesthesiologist at Washington University School of Medicine in St. Louis.
In anesthesiology, he says, the forecasters simply measured the number of procedures and did not recognize that operations were taking more time and that more of them were taking place in outpatient settings, such as ambulatory surgery centers.
Now anesthesiologists are thought to be in shortage, he says.
The lesson, Owens told the subcommittee, is that "we can't direct the marketplace."
The subcommittee's proposed new policy, unveiled at the hearing, takes a more neutral tone than the old policy. It says, in part, that the "the AMA should work to ensure an adequate supply of physicians in all specialties."
The proposal also states that there should be no decrease in residency slots.
If the proposal becomes new AMA policy, Busharat Ahmad, M.D., a member of the AMA's international medical graduate section, says he hopes it will prompt residency accreditors to open up more training slots to IMGs.