I’ll start this post with full disclosure: I am a medical
educator, and have spent a good portion of my professional life educating
trainees (residents) to prepare for independent practice. My specialty is combined internal
medicine-pediatrics, or “Med-Peds” for short, and my personal clinical practice
is primary care for the underserved.
I have been very interested in what the future health care
environment will look like, and thus follow updates from agencies that comment
on the future of health care, as well as the supply of physicians and other
health care providers.
There are some facts about which very few disagree, and
there are others where interpretations are very different. We do know that many new medical schools have
opened up within the past few years, and also that many existing medical
schools have increased matriculation.
From this, it would seem as if the supply of physicians to
care for future generations is being addressed.
But remember that, to be a physician practicing independently, one must
graduate medical school, and also complete residency training. It is this part, the percentage of
residency training positions, which has NOT increased as much as the medical
school matriculation. The actual number
of positions has increased, but not at the same rate as medical school
graduates (see Figure 1). In short, the “bottleneck” for US
students to become practicing physicians is indeed US residency positions,
known as GME, or graduate medical education.
The National Residency Match Program (NRMP) does state that there are enough GME positions for all US
graduates, but there are other graduates (from international medical schools) applying
for these same positions.
This was a busy week for such projections. The AAMC came out with a roadmap earlier this week describing plans for how to address this situation. The Commonwealth Fund, however, delivered
another interpretation of the situation, stating that the current healthcare
situation can handle the influx of new patients as a result of the Affordable Care
Act. This follows on the heels of the IOM report last year addressing the GME issue and recommending no additional funding for new
residency positions, among other things.
So who is correct? I
admit my biases on this topic, in that a) I am an educator, and attend the AAMC meetings, and
b) I practice in a state where even the Commonwealth Fund writes that there are
fewer primary care docs. For the record,
our Med-Peds residency program is the largest one in the country, and has been
for at least 20 years. About 40-45% of
our graduates choose primary care as their ultimate specialty, higher than
either hospital medicine or further fellowship subspecialty training. This percentage of graduates choosing primary care was higher in the 1990s.
I’m curious what readers of this blog think about the
situation. Is there a doctor shortage,
and is there a shortage of primary care physicians? Will patients be able to get access to health
care given the influx of new patients into the health care system? What else should be done besides the roadmap
outlined by the AAMC?
Thanks for reading; I’m curious to hear differing opinions.
