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The U.S. Physician Workforce: Beyond the Numbers

The U.S. Physician Workforce: Beyond the Numbers. Fitzhugh Mullan, MD The George Washington University National Health Policy Conference February 13, 2007. Physician Workforce History: Key Dates. 1963 – Enactment of the Health Professions Education Assistance Act

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The U.S. Physician Workforce: Beyond the Numbers

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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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