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What is the solution to addressing US physician shortages?

By Kyle Murphy, PhD

- As the American Medical Association (AMA) continuing its push to address the causes and identify solutions to physician shortages across the United States in response to a recent report by the Institute of Medicine (IOM), others are suggesting other solutions.

The IOM report published earlier this week focused on the governance and financing associated with graduate medical education (GME) based on an independent review of a 21-member IOM committee. Ultimately, it concluded that continued Medicare (i.e., public) support over the next ten years was necessary “to drive more strategic investment in the nation’s physician workforce.”

The AMA, however, disagrees. In a statement by Immediate Past President Ardis Dee Hoven, MD, the association voiced its concerns with the findings:

While the AMA appreciates the Institute of Medicine’s efforts to review graduate medical education governance and funding, we remain concerned about the need to recognize the nation’s potential physician shortages and the need for adequately funded physician training.

Despite the fact that workforce experts predict a shortage of more than 45,000 primary care and 46,000 specialty physicians in the U.S. by 2020, the report provides no clear solution to increasing the overall number of graduate medical education positions to ensure there are enough physicians to meet actual workforce needs.

The AMA’s solution is to increase the number of residency slots and size of medical school classes. As part of this effort, it advocating for the Creating Access to Residency Education Act of 2014 (CARE Act), which would provide federal grants for new residency positions, and also urging state legislatures to follow suit.

Another solution?

Researchers from the University of North Carolina–Chapel Hill believe that they have created their own solution to the physician shortage predicament.

With funding from the Physicians Foundation, a development team led by Erin Fraher, PhD, has launched the FutureDocs Forecasting tool that “estimates the supply of physicians, use of physician services, and capacity of the physician workforce to meet future use of health services at the sub-state, state and national levels.”

According to Fraher, the purpose behind the tool’s development is to expand the conversation about physician shortages.

“It’s important to recognize that the national dialogue about physician supply has been narrowly focused until now,” she argued in a public statement. “Using the number of physician specialists in a region as a sole indicator of how well patients’ needs will be met in the future is neither accurate nor useful. Instead, we need to emphasize how alternative combinations of physicians can provide the needed services in a market area.”

The inclusion of clinical feedback alongside data and projections is intended to give policy makers a more realistic view of care delivery in various geographies.

So far the findings indicate the potential for redistributing current practitioners to prevent physician shortages in certain areas from negatively impacting patient access to adequate healthcare:

• The number of pediatric surgery patient care FTEs is projected to double from 2011 to 2030, with growth occurring throughout most of the country. This finding contrasts with current concerns about a pediatric surgeon shortage.

• General internal medicine in the US is projected to experience a 12 percent decline in patient care FTEs between 2011 and 2030.

• Between 2014 and 2030, population growth and aging will be more significant contributors to rising healthcare use than the Affordable Care Act’s health insurance coverage expansion.

• By 2030, many specialties that were previously majority male will become over 50 percent female.

• The number of mental health visits exceeds provider capacity in the majority of areas in 2011, and these geographic disparities become more pronounced by 2030.

Obviously, the perspectives of the AMA and UNC researchers can both be right, signaling a new for multiple approaches to ensuring that patients have access to healthcare.

“This model is not intended to provide a single right answer to address physician shortages,” added Dr. Fraher. “Our hope is that the FutureDocs Forecasting Tool will reframe how people think about physician supply and demand, and that the data each customized criteria selection yields will help educate and engage stakeholders to create actionable workforce policy at the local and national levels.”




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