Where Have All The Doctors Gone?

1. Where Have All The Doctors Gone? A Public Health Crisis William H. Harvey, Ph.D. Emeritus Professor of Biology- Advisor/Consultant Earlham College

2. Dramatic increase in MS grads • First year MS enrollment in 2016 will reach 22,000, a 30% increase over 2003 as proposed by AAMC • 58% will come from 125 current MS, 25% from 12 new MS and 17% balance from MS in LCME review = 141 total • D.O. enrollment now at 6200 double that of 2003 (number of new schools) • Combined MD and DO enrollment will reach 27,000 an increase of 37% over 2003 • This number is approximately equal to the IMG that enter GME each year • Thus approximately 54,000 medical students are in competition for GME

3. Reducing Medicare GME will worsen physician shortage • Proposed GME Medicare cuts (60-70%) – ACA related???? • Targets teaching hospitals (6% of all 5,800 hospitals) • These hospitals, about 350, provide 75% of all GME • 80% of all ACS certified level 1 trauma centers • 28% of all Medicaid inpatient care • 40 % of all inpatient charity care

5. Teaching hospitals under financial crisis train tomorrow’s doctors • Our nation faces a growing shortage of doctors • By 2015, the shortage will reach 62K in all specialties • By 2025, the shortage will reach 130K • The Medicare population will grow by 36% over next 10 years • 1/3 of physicians will reach 60 and will retire in 10 years

6. Doctor shortfall • In 2008, all specialties = currently 700,000 doctors in practice in N. America • By 2020, demand will approach 900,000 doctors • 45,000 too few primary care doctors now • 46,000 surgeons and medical specialist shortage now • Total physician shortage in 2020 = 91,500 • Impact most severe on vulnerable and underserved pop • Consider implications of a 36% increase in Americans over age 65 • Implications of health care demand through the ACA

7. 2013 match left hundreds of applicants without a spot • 26,700 residency slots = sum of MD/DO grads • In 2010, MD-94%; DO -71%; IMG – 52% matched • Currently 110,000 residents in training annually • Cost of resident training is $100k/year: Medicare = 40% • Total hospital costs = $13 B: Medicare = $3 B • Approx. 35,000 enter GME annually (Program Year 1) • Additional residency slots over 26,700 are often “subsidized”

9. The New Environment • Recent evidence from AAMC about 1000 US grads failed to match last year • Efforts by the AAMC and other academic organizations to increase the net number of new GME positions have not met with success • Matching for the IMG will become increasingly more difficult

10. What does the IMG do to be competitive for these GMEs • Strong Board Scores • Grades and honors • Recommendation letters • Timely submission of materials • Research • Making contact with decision makers (doing an effective rotation) • A good interview • Indicate a commitment to primary care!

11. How can Polish MS address this doctor shortage • Recruit and retain strong students • Provide strong academic support in first two years including resources for test prep • Stay informed regarding ACGME residency issues: FREIDA et.al • Provide as much internship opportunities statewide as possible: encourage networking- “observational relationships” critical • Attempt to develop new sites for GME training in new hospital sites: this may require some capital investment, “subsidy” • strength in numbers = coalition of Polish MS effort?

12. Selected references • Results of the 2011 Medical School Enrollment Survey: Center for Workforce Studies, May 2012 • AAMC Physician Workforce Policy Recommendations, Sept 2012 • Projected Supply and Demand, Physicians, 2008-2020, AAMC • Accreditation Council for Graduate Medical Education • Preserve Medicare Support for Physician Training: AAMC • What does Medicare have to do with GME: AAMC

13. Thank you for your interest • Please call upon me if I can be helpful • Questions? Please come by and introduce yourself! • Again I am: William H. Harvey, Ph.D. billh@earlham.edu