Smoothing Disparities in Physician Supply: A Role for Graduate Medical Education?
October 25, 2013
William J. Scanlon, PhD, Consultant & Sally Coberly, PhD
Population growth, the aging of the population, and expanded insurance coverage have raised concerns about a potential shortage of physicians to meet future demands for care. Discussions of a national shortage, however, overlook a possibly more immediate and important reality: there are two-fold differences across states in the number of practicing physicians per capita. While allopathic medical school capacity has expanded by 30 percent in response to shortage concerns, there has not been a commensurate increase in residency training positions which are required before medical school graduates can begin practicing. Calls have been made to lift the cap on Medicare-supported residency slots in place since the Balanced Budget Act of 1997. Proposals to lift the cap have also focused on what types (primary versus specialty care) and locations of residencies would be supported. The location of new residency programs affects the geographic distribution of physicians because physicians are likely to practice in the same area in which they trained as a resident.
This Forum session examined geographic disparities in physician supply, the effect of residency training location on practice location, the interest and abilities of hospitals to start or expand new residency programs, and state efforts to promote graduate medical education (GME). It also included a discussion of recently initiated residency programs and the challenges they faced.
See also "Challenges of Forecasting Physician Workforce Needs Amid Delivery System Transformation" (Issue Brief No. 855, September 29, 2015; originally published as "Health Workforce Needs: Projections Complicated by Practice and Technology Changes," October 22, 2013) and "Aligning Graduate Medical Education with Public Policy" (Background Paper No. 82, September 14, 2011)
Other resources include:
- Julie C. Spero et al., "GME in the United States: A Review of State Initiatives," The Cecil G. Sheps Center for Health Services Research, University of North Carolina, September 2013
- Michael E. Whitcomb, MD, New and Developing Medical Schools, Part 2, Josiah Macy Jr. Foundation, July 2013
- Macy Foundation, Ensuring an Effective Physician Workforce for America Recommendations for an Accountable Graduate Medical Education System, Revised November 2011
- Uwe E Reinhardt, testimony to U.S. Senate Committee on Health, Education, Labor, and Pensions, Subcommittee on Primary Health and Aging, hearing on "30 Million New Patients and 11 Months to Go: Who Will Provide Their Primary Care?" January 29, 2013