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COGME Physician Workforce Policies: Recent Developments and Remaining Challenges in Meeting National Goals March 1999 The full version of this report is available in PDF format (309 KB)
Executive Summary
The past decade has seen changes in the American health care system that have the potential to significantly impact on the nation’s physician supply and requirements. In addition, in the past two years there have been a number of statutory
and non-statutory policy changes related to graduate medical education (GME), including the passage of the Balanced Budget Act (BBA) in 1997 and an expansion of State GME activities.
This report assesses recent developments and policies related to the physician workforce and GME, and their potential impact on the supply, demand and training of physicians in the coming years. Among the significant developments reviewed in the report are: the increasingly competitive marketplace for health services; the 1997 Balanced Budget Act; expanded State GME financing activities; the growth in the supply of non-physician clinicians; and new GME policies at the Department of Veterans Affairs. As part of this assessment, the report calculates the progress that has been made
towards the goals of the Council on Graduate Medical Education (COGME) for decreasing the total number of new physicians and increasing the percent in generalist specialties. Based on the assessment of recent developments, the report recommends a new framework for Federal GME policies and programs.
KEY FINDINGS
FINDING 1: The rate of growth in the physician supply has moderated slightly but is still likely to lead to a surplus of physicians. To help avoid a surplus of physicians, particularly specialists, the Council previously recommended that
the number of new physicians entering training be equal to 110 percent of the number of U.S. medical school graduates in 1993 (COGME Fourth Report, 1994; Eighth Report, 1996). The Council finds that only limited progress has been made to date in reducing the number of physicians in training and in 1997, 129 percent of the number of 1993 U.S. medical
school graduates entered residency training. The number of specialists being trained exceeds the target
established by COGME by 41 percent, more than 4,000 physicians per year.
The number of physicians in training appears to be leveling off and is likely to decrease for the next few years. The number of new entrants, particularly international medical school graduates (IMGs), has decreased moderately over the past five years. The recent trends may reflect anticipation of reduced support for GME in general, the growing concern with surpluses in some specialties, and/or declining hospital inpatient use. Many of the most recent developments, particularly marketplace pressures, the Balanced Budget Act, and the Federal Medicare resident reduction demonstration in New
York, encourage downsizing the number of residents. Despite these developments, it seems unlikely that the 110 percent goal will be reached within the next five years.
FINDING 2: The number of generalist physicians is increasing. Despite concern about a general oversupply of physicians, the Council has consistently recommended an increase in the number of generalists being trained. This reflects concerns about existing physician shortages, particularly in underserved areas, and the expectation that the expansion of managed care would lead to an increase in demand for generalists. The Council finds that substantial progress has been made in increasing the number of physicians entering or planning to enter generalist specialties.
The Council’s goal for the number of generalists to be produced each year is usually expressed as a percent of the goal for the total physician supply for each year: 50 percent (generalists) of 110 percent of the 1993 graduates of U.S. medical schools. The Council concludes that 40 percent of the current entering residents are likely to go into generalist specialties. However, this is 40 percent of the 129 percent of the 1993 graduates entering training. In absolute numbers, this translates into a modest under-production of generalists compared to the COGME goals. The Council finds that the nation is producing 9,217 generalists each year compared to a goal of 9,879, a shortfall of 662, or about 7 percent. This represents significant progress from earlier years. Although the nation is still falling short, the generalist goal appears to be
within reach and is likely to be achieved in the next few years.
The marketplace, particularly a growing surplus in some subspecialties, may be contributing to the increase in interest of new physicians in generalist specialties. State policies, private sector initiatives and new VA policies also appear to be contributing. Recent surveys of medical students and the results of the National Residency Match Program document the increased interest in generalist specialties by U.S. medical school students.
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