Transcript Where have all the doctors gone?
Where Have All The Doctors Gone?
A Public Health Crisis William H. Harvey, Ph.D.
Emeritus Professor of Biology- Advisor/Consultant Earlham College
Dramatic increase in MS grads
First year MS enrollment in 2016 will reach 22,000, a 30% increase over 2003 as proposed by AAMC
58% will come from 125 current MS, 25% from 12 new MS and 17% balance from MS in LCME review = 141 total
D.O. enrollment now at 6200 double that of 2003 (number of new schools)
Combined MD and DO enrollment will reach 27,000 an increase of 37% over 2003
This number is approximately equal to the IMG that enter GME each year
Thus approximately 54,000 medical students are in competition for GME
Reducing Medicare GME will worsen physician shortage
Proposed GME Medicare cuts (60-70%) – ACA related????
Targets teaching hospitals (6% of all 5,800 hospitals)
These hospitals, about 350, provide 75% of all GME
80% of all ACS certified level 1 trauma centers
28% of all Medicaid inpatient care
40 % of all inpatient charity care
Teaching hospitals under financial crisis train tomorrow’s doctors
Our nation faces a growing shortage of doctors
By 2015, the shortage will reach 62K in all specialties
By 2025, the shortage will reach 130K
The Medicare population will grow by 36% over next 10 years
1/3 of physicians will reach 60 and will retire in 10 years
Doctor shortfall
In 2008, all specialties = currently 700,000 doctors in practice in N. America
By 2020, demand will approach 900,000 doctors
45,000 too few primary care doctors now
46,000 surgeons and medical specialist shortage now
Total physician shortage in 2020 = 91,500
Impact most severe on vulnerable and underserved pop
Consider implications of a 36% increase in Americans over age 65
Implications of health care demand through the ACA
2013 match left hundreds of applicants without a spot
26,700 residency slots = sum of MD/DO grads
In 2010, MD-94%; DO -71%; IMG – 52% matched
Currently 110,000 residents in training annually
Cost of resident training is $100k/year: Medicare = 40%
Total hospital costs = $13 B: Medicare = $3 B
Approx. 35,000 enter GME annually (Program Year 1)
Additional residency slots over 26,700 are often “subsidized”
The New Environment
Recent evidence from AAMC about 1000 US grads failed to match last year
Efforts by the AAMC and other academic organizations to increase the net number of new GME positions have not met with success
Matching for the IMG will become increasingly more difficult
What does the IMG do to be competitive for these GMEs
Strong Board Scores
Grades and honors
Recommendation letters
Timely submission of materials
Research
Making contact with decision makers (doing an effective rotation)
A good interview
Indicate a commitment to primary care!
How can Polish MS address this doctor shortage
Recruit and retain strong students
Provide strong academic support in first two years including resources for test prep
Stay informed regarding ACGME residency issues: FREIDA et.al
Provide as much internship opportunities statewide as possible: encourage networking- “observational relationships” critical
Attempt to develop new sites for GME training in new hospital sites: this may require some capital investment, “subsidy”
strength in numbers = coalition of Polish MS effort?
Selected references
Results of the 2011 Medical School Enrollment Survey: Center for Workforce Studies, May 2012
AAMC Physician Workforce Policy Recommendations, Sept 2012
Projected Supply and Demand, Physicians, 2008-2020, AAMC
Accreditation Council for Graduate Medical Education
Preserve Medicare Support for Physician Training: AAMC
What does Medicare have to do with GME: AAMC
Thank you for your interest
Please call upon me if I can be helpful
Questions? Please come by and introduce yourself!
Again I am: William H. Harvey, Ph.D.