Where Have All Where Have All The Doctors The Doctors

Gone?Gone?A Public Health CrisisA Public Health Crisis

William H. Harvey, Ph.D.William H. Harvey, Ph.D.Emeritus Professor of Biology- Advisor/ConsultantEmeritus Professor of Biology- Advisor/Consultant

Earlham CollegeEarlham College

Dramatic increase in Dramatic increase in MS gradsMS grads

First year MS enrollment in 2016 will reach 22,000, a First year MS enrollment in 2016 will reach 22,000, a 30% increase over 2003 as proposed by AAMC 30% increase over 2003 as proposed by AAMC

58% will come from 125 current MS, 25% from 12 new MS 58% will come from 125 current MS, 25% from 12 new MS and 17% balance from MS in LCME review = 141 totaland 17% balance from MS in LCME review = 141 total

D.O. enrollment now at 6200 double that of 2003 D.O. enrollment now at 6200 double that of 2003 (number of new schools)(number of new schools)

Combined MD and DO enrollment will reach 27,000 an Combined MD and DO enrollment will reach 27,000 an increase of 37% over 2003 increase of 37% over 2003

This number is approximately equal to the IMG that This number is approximately equal to the IMG that enter GME each yearenter GME each year

Thus approximately 54,000 medical students are in Thus approximately 54,000 medical students are in competition for GMEcompetition for GME

Reducing Medicare GME Reducing Medicare GME will worsen physician will worsen physician

shortageshortage Proposed GME Medicare cuts (60-70%) – ACA Proposed GME Medicare cuts (60-70%) – ACA related????related????

Targets teaching hospitals (6% of all 5,800 Targets teaching hospitals (6% of all 5,800 hospitals)hospitals)

These hospitals, about 350, provide 75% of all These hospitals, about 350, provide 75% of all GMEGME

80% of all ACS certified level 1 trauma centers80% of all ACS certified level 1 trauma centers

28% of all Medicaid inpatient care28% of all Medicaid inpatient care

40 % of all inpatient charity care40 % of all inpatient charity care

Teaching hospitals under Teaching hospitals under financial crisis train financial crisis train

tomorrow’s doctorstomorrow’s doctors Our nation faces a growing shortage of Our nation faces a growing shortage of doctorsdoctors

By 2015, the shortage will reach 62K in all By 2015, the shortage will reach 62K in all specialtiesspecialties

By 2025, the shortage will reach 130KBy 2025, the shortage will reach 130K

The Medicare population will grow by 36% over The Medicare population will grow by 36% over next 10 yearsnext 10 years

1/3 of physicians will reach 60 and will 1/3 of physicians will reach 60 and will retire in 10 yearsretire in 10 years

Doctor shortfallDoctor shortfall

In 2008, all specialties = currently 700,000 doctors In 2008, all specialties = currently 700,000 doctors in practice in N. Americain practice in N. America

By 2020, demand will approach 900,000 doctorsBy 2020, demand will approach 900,000 doctors

45,000 too few primary care doctors now45,000 too few primary care doctors now

46,000 surgeons and medical specialist shortage now46,000 surgeons and medical specialist shortage now

Total physician shortage in 2020 = 91,500Total physician shortage in 2020 = 91,500

Impact most severe on vulnerable and underserved popImpact most severe on vulnerable and underserved pop

Consider implications of a 36% increase in Americans Consider implications of a 36% increase in Americans over age 65over age 65

Implications of health care demand through the ACAImplications of health care demand through the ACA

2013 match left hundreds 2013 match left hundreds of applicants without a of applicants without a

spotspot 26,700 residency slots = sum of MD/DO grads26,700 residency slots = sum of MD/DO grads

In 2010, MD-94%; DO -71%; IMG – 52% matchedIn 2010, MD-94%; DO -71%; IMG – 52% matched

Currently 110,000 residents in training annually Currently 110,000 residents in training annually

Cost of resident training is $100k/year: Medicare = Cost of resident training is $100k/year: Medicare = 40%40%

Total hospital costs = $13 B: Medicare = $3 BTotal hospital costs = $13 B: Medicare = $3 B

Approx. 35,000 enter GME annually (Program Year 1)Approx. 35,000 enter GME annually (Program Year 1)

Additional residency slots over 26,700 are often Additional residency slots over 26,700 are often “subsidized”“subsidized”

The New EnvironmentThe New Environment

Recent evidence from AAMC about 1000 US Recent evidence from AAMC about 1000 US grads failed to match last yeargrads failed to match last year

Efforts by the AAMC and other academic Efforts by the AAMC and other academic organizations to increase the net number organizations to increase the net number of new GME positions have not met with of new GME positions have not met with successsuccess

Matching for the IMG will become Matching for the IMG will become increasingly more difficultincreasingly more difficult

Strong Board ScoresStrong Board Scores

Grades and honorsGrades and honors

Recommendation lettersRecommendation letters

Timely submission of materials Timely submission of materials

ResearchResearch

Making contact with decision makers (doing an Making contact with decision makers (doing an effective rotation)effective rotation)

A good interviewA good interview

Indicate a commitment to primary care!Indicate a commitment to primary care!

What does the IMG do to What does the IMG do to be competitive for these be competitive for these

GMEsGMEs

How can Polish MS How can Polish MS address this doctor address this doctor

shortageshortage Recruit and retain strong students Recruit and retain strong students

Provide strong academic support in first two years Provide strong academic support in first two years including resources for test prepincluding resources for test prep

Stay informed regarding ACGME residency issues: Stay informed regarding ACGME residency issues: FREIDA et.alFREIDA et.al

Provide as much internship opportunities statewide as Provide as much internship opportunities statewide as possible: encourage networking- “observational possible: encourage networking- “observational relationships” criticalrelationships” critical

Attempt to develop new sites for GME training in new Attempt to develop new sites for GME training in new hospital sites: this may require some capital hospital sites: this may require some capital investment, “subsidy”investment, “subsidy”

strength in numbers = coalition of Polish MS effort?strength in numbers = coalition of Polish MS effort?

Selected referencesSelected references

Results of the 2011 Medical School Enrollment Survey: Results of the 2011 Medical School Enrollment Survey: Center for Workforce Studies, May 2012Center for Workforce Studies, May 2012

AAMC Physician Workforce Policy Recommendations, Sept AAMC Physician Workforce Policy Recommendations, Sept 20122012

Projected Supply and Demand, Physicians, 2008-2020, Projected Supply and Demand, Physicians, 2008-2020, AAMCAAMC

Accreditation Council for Graduate Medical EducationAccreditation Council for Graduate Medical Education

Preserve Medicare Support for Physician Training: Preserve Medicare Support for Physician Training: AAMCAAMC

What does Medicare have to do with GME: AAMCWhat does Medicare have to do with GME: AAMC

Thank you for your Thank you for your interestinterest

Please call upon me if I can be helpfulPlease call upon me if I can be helpful

Questions? Please come by and introduce Questions? Please come by and introduce yourself!yourself!

Again I am: William H. Harvey, Ph.D.Again I am: William H. Harvey, Ph.D.

billh@earlham.edubillh@earlham.edu