Reversing longstanding policy, a federal committee that advises Congress on physician supply has determined there is a shortage of physicians and is calling for a 15% increase in the number of medical school graduates by 2015.
But experts say it could take decades to see an increase in physicians at the other end of the educational pipeline, and that graduating more doctors might require lowering academic standards.
The change in policy at the Council on Graduate Medical Education, known as COGME, is "an about-face," says COGME Chairman Carl Getto, M.D.
"The world was a lot different in the early 1990s, when we last looked at this," says Getto, who is senior vice president for medical staff affairs and associate dean for hospital affairs at the University of Wisconsin Hospital & Clinics in Madison.
Back in the mid-1990s, after new medical schools were built and managed care promised new efficiencies that didn't require as many doctors, COGME declared there would soon be a surplus of physicians, he says.
At that time, Getto says the group embraced a policy that residents should be kept at 110% of the number of U.S. medical school graduates, supplemented by international medical graduates, and that half of all residency slots should be in primary care.
Getto says COGME's recent decision at a Sept. 17 meeting was based on the findings of a study by Edward Salsberg, executive director of the Center for Workforce Studies at the State University of New York in Albany.
The study projects a shortage of 85,000 to 96,000 physicians by 2020. It recommends that U.S. medical schools should graduate 3,000 more physicians in the next 12 years, a goal that the study says would probably require opening four to five new schools.
Others also are considering revisions in physician workforce policies. In June, a subcommittee of the AMA Council on Medical Education proposed to change an AMA policy that still states "there currently is, or soon will be, a surplus of physicians in many regions and specialties." The group will present a report to the AMA House of Delegates in December.
Numerous reports in the past few years have warned of impending shortages, especially for specialists. A study in the August issue of the Annals of Surgery finds that most surgical specialties will confront shortages by the year 2020, due in part to an aging population.
But physician supply experts warn that it could take literally decades before higher numbers of fully trained physicians emerge from the educational pipeline. Apart from the years it would take to expand medical school facilities to accommodate a higher enrollment, medical school and residency training takes seven to 11 years to complete, they say.
Meanwhile, experts fear that an expansion of medical schools could come at the price of lower academic standards, as medical schools are seeing a drop-off in applications.
Last month, the Journal of the American Medical Association reported that medical school applications had dropped 22% from 1997 to 2002.
Getto says he would like COGME to commission regular reports on physician supply, but the council was sunsetted after its last meeting and officially no longer exists.
Getto says a provision in the Senate version of the federal budget bill would reauthorize COGME. The House bill does not do so, he says.