After more than a decade of warnings about a doctor surplus, a federal advisory group that tracks workforce issues now says the U.S. should boost its number of medical school graduates by at least 3,000 over the next decade to combat a growing physician shortage.
The recommendation represents a sharp turnaround for the Council on Graduate Medical Education, an advisory body authorized by Congress to help shape the federal government's policy on the size of the physician workforce. The about-face was first disclosed in Modern Healthcare's Daily Dose on Oct. 3.
Reversing its longstanding position that the nation faces a physician surplus in the coming years, the council endorsed an increase in medical students and a corresponding rise in the number of first-year residency slots from about 24,000 to almost 27,000 by the year 2015.
"It's a total pirouette-and a long time in coming," said Richard Cooper, a physician and an expert on the workforce issue who is director of the Health Policy Institute at the Medical College of Wisconsin, Milwaukee.
The sudden shift in the council's position came in the wake of a report it commissioned from Edward Salsberg, executive director of the Center for Health Workforce Studies at the State University of New York, Albany, which projected a shortage of 85,000 to 96,000 physicians by 2020.
The council endorsed the key elements in Salsberg's report during a recent meeting, signaling the potential for change in government policy on physician supply.
"I think it reflects a changing of the official position of the council, and I think it reflects a change in thinking in this country," Salsberg said.
One bureaucratic and budgetary hitch, however, may prevent any official action on the council's endorsement of Salsberg's recommendations. The council's federal authorization expired Sept. 30, and it now is officially in limbo until Congress acts on the 2004 federal budget.
Though funding for the council is included, no one is willing to guarantee congressional approval. Even if it is reauthorized, the council actually has no real authority to change federal policy as an advisory council.
"Right now, we are no longer an official organization," said Carl Getto, a physician who is senior vice president of medical affairs at the University of Wisconsin-Madison. Getto will continue as the council's chair if it receives a new charter. "We hope we'll be reauthorized. But nothing is certain."
Even if Congress or the states act immediately on the recommendations, it will be several years before an influx of new doctors would help relieve current pressures on physician recruitment, said Monica Reed, senior medical officer at seven-facility Florida Hospital in Orlando. Reed has been struggling to fill specialist slots for the last several years.
"It's a current concern," she said, "and one that is going to get worse with time, not better."
The number of medical school graduates has held steady at just under 16,000 per year for much of the past two decades.
Salsberg believes a boost in the number of medical students could be achieved through the creation of four or five new medical schools, with the existing 126 medical institutions absorbing most of the suggested increase of 3,000 students. Cooper suggested, though, that two dozen or more new schools are needed.
"The real issue is where will the money come from?" Getto said.
The advisory council isn't the only agency reconsidering this topic. Since 1997, the Chicago-based American Medical Association has maintained that a surplus of doctors exists everywhere but in scattered geographic areas that face shortages in certain specialties.
"When we last looked at this policy in 1997, there was a belief that there was not a need for any additional medical schools, and no need for a general increase in the number of residencies," said James Rohack, a member of the AMA's board of trustees. "It's time to revisit that."
The Washington-based Association of American Medical Colleges, which represents the nation's 126 allopathic medical schools, also is poised to change its longtime position on the issue.
"I think there is a level of concern about this issue that didn't exist just a few years ago," said Michael Whitcomb, senior vice president of the association's division of medical education. "We've always held that the implications of a physician shortage are more serious than a physician oversupply. And that heightens the concern."