Special Feature

How the AMA is addressing the growing physician shortage

With as many as 32 million new patients entering the nation's health care system in 2014, many experts believe this influx will exacerbate the current physician shortage and lead to even greater shortfalls in the future.

Over the past decade, medical school enrollments have risen in response to this anticipated shortfall in physicians, but the bottleneck is in graduate medical education (GME). Since the enactment of a Medicare residency funding cap in 1997, growth in the number of core GME programs has been minimal. Without more funding for positions, the physician workforce cannot grow to meet the nation's needs.

To help address the shortage, the AMA supports adequate and stable GME funding as well as more training in non-hospital ambulatory settings, including physicians' offices, nursing homes and community-based programs. Learn more. The AMA also is in favor of S. 1627, the Resident Physician Shortage Reduction Act of 2011, which would expand the number of Medicare-supported GME positions by 15 percent over five years. Similar legislative efforts are under way in Congress, as reported in  American Medical News and Bloomberg BusinessWeek.

In addition, the AMA is closely monitoring the work of a new Institute of Medicine (IOM) committee charged with reviewing the nation's GME system and making recommendations on how to better produce a medical workforce for the 21st century. The committee took its first steps recently with a two-day meeting in Washington, D.C., and will meet again in December.

The committee is tasked with reviewing the current number of residents and GME slots against the number needed to address such issues as the nation's aging and increasingly diverse patient population, the growing prevalence of disability and chronic disease, and new health care innovations. The committee's recommendations are not expected to be released until late 2013.

More than $9 billion annually in Medicare funding goes to support residency training. However, "there's been a growing concern about whether the money from Medicare, in particular, was being spent appropriately," IOM committee member Robert Baron, MD, associate dean of GME at the University of California–San Francisco (UCSF), said in a story on the UCSF website. "Is there sufficient value for the Medicare money being spent?"

Another question the IOM committee will address: Should more federal funds go toward training non-physicians to help relieve the burden from the projected doctor shortage? A new report from the American Academy of Family Physicians (AAFP), "Primary Care in the 21st Century," argues against such substitution in favor of a team-based approach within a physician-led, patient-centered medical home. The report has garnered support from the AMA, the American Academy of Pediatrics and the American Osteopathic Organization, which have joined the AAFP in advocating for the medical home model.

Another organization looking at GME and workforce concerns is the Council on Graduate Medical Education (COGME), chaired by David Goodman, MD, professor of pediatrics at the Dartmouth Institute for Health Policy and Clinical Practice. COGME met this summer to discuss its upcoming report, "Restructuring Graduate Medical Education."

Finally, the Association of American Medical Colleges has developed an advertising campaign in newspapers near the sites of the presidential debates on the need for GME expansion. The full-page ads urge Congress to lift the GME cap and cautions voters, "By the time you notice America's doctor shortage, it will be too late."