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U.S. Physician Workforce: Historical Insights and Future Challenges

This presentation by Dr. Fitzhugh Mullan at the George Washington University National Health Policy Conference dives into the evolution of the U.S. physician workforce. It highlights key legislative milestones, including the Health Professions Education Assistance Act and the implications of various reports and reforms impacting medical education and residency training. The discussion covers the growth in medical schools and graduates, the role of international medical graduates, and current questions about the sufficiency of the physician workforce. A vital resource for understanding healthcare dynamics in the U.S.

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U.S. Physician Workforce: Historical Insights and Future Challenges

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  1. The U.S. Physician Workforce:Beyond the Numbers Fitzhugh Mullan, MD The George Washington University National Health Policy Conference February 13, 2007

  2. Physician Workforce History: Key Dates • 1963 – Enactment of the Health Professions Education Assistance Act • Construction, Scholarships, Capitation $$$ • 1964 – Civil Rights Act • 1971 – Reauthorization of the HPEA • NPs and PAs • AHECs • 1976 – Reauthorization of the HPEA • Funding significantly decreased • PC and underservice added as priorities

  3. Key Dates II • 1980 – GMENAC Report • Predicted substantial MD surpluses • 1983 – Medicare PPS Implemented • DME and IGME payments begun • 1992-1994 – Health Care Reform Debate • GME funding linked to workforce goals proposed...unsuccessfully • 1994 – COGME Calls for 50-50/110

  4. Key Dates III • 1997 – Balanced Budget Amendment • Caps Medicare funded residency slots • 2005 – COGME Calls for 15% Increase in Medical Student Enrollment • 2006 – AAMC Calls for 30% Increase in MedicalStudent Enrollment • 2007 – Title VII Slated for Elimination

  5. What Happened • Medical Schools Increased from 87 in 1965 to 126 in 1980 • Graduates Increased from ~8,000/yr in 1965 to ~16,500/yr in 1980 • From 1980 to the present graduates have remained at ~16,500/yr • Osteopathic Schools have grown steadily from 5 to 20 now graduating ~3000/yr

  6. What Happened II • Residents grew from ~60,000 in 1965 to ~100,000 in 1992 and have remained at that level • IMGs have grown from ~10% of residents to ~25% of residents…and 25% of practicing physicians today

  7. Applicants to Allopathic Medical Schools and Enrollment (Source: AMA)

  8. Number of Residents in U.S. Allopathic Training Programs from 1993-2003 (Source: AMA)

  9. Number of Residents in U.S. Allopathic Training Programs According to the Type of Medical School Attended from 1993-2003(Source: AMA)

  10. Supply of Active Physicians (MD & DO) and Ratio to Population Actual 1950-1990 and Projected 2000-2020 Physicians Per 100,000 Population Population is U.S. civilian population including possessions

  11. Title VII Appropriations 1964-2007

  12. Title VII and Medicare GME(2006 dollars)

  13. Characteristics of Physician Workforces of US, UK, Canada, and Australia.

  14. G. Anderson et al. Health Affairs, 25, no. 3 (2006)

  15. Current Questions • More Medical Schools? • More Residents? • More Medicare GME? • More/less physicians from abroad? • Would more doctors make America healthier…happier…richer…poorer?

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