The U.S. Physician Workforce:Beyond the Numbers

Fitzhugh Mullan, MDThe George Washington University

National Health Policy ConferenceFebruary 13, 2007

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

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

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 Medical Student Enrollment

• 2007 – Title VII Slated for Elimination

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

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

Applicants to Allopathic Medical Schools and Enrollment (Source: AMA)

Year No. of Applicants

No. Accepted Applied: Accepted

Ratio

No. Enrolled Mean GPA of Applicants

1980 36,100 17,146 2.1 16,590 3.32

1992 37,408 17,464 2.1 16,289 3.24

1993 42,808 17,362 2.5 16,307 3.26

1994 45,364 17,317 2.6 16,287 3.28

1995 46,591 17,357 2.7 16,253 3.31

1996 46,967 17,385 2.7 16,201 3.34

1997 43,018 17,313 2.5 16,165 3.38

1998 40,998 17,374 2.4 16,170 3.40

1999 38,449 17,424 2.2 16,221 3.43

2000 37,092 17,538 2.1 16,301 3.44

2001 34,859 17,456 2.0 16,365 3.45

2002 33,625 17,592 1.9 16,488 3.46

2003 34,786 17,539 2.0 16,538 3.47

2004 35,735 17,662 2.0 16,648 3.47

2005 37,373 17,987 2.1 17,003 3.48

2006 39,108 18,442 2.1 17,370 3.48

Number of Residents in U.S. Allopathic Training Programs from 1993-2003 (Source: AMA)

103,106101,29199,96498,25896,41096,80697,98997,38398,14398,03597,83297,370 98,076

25,73723,78923,92223,44323,03424,68125,49824,57124,51624,60824,17025,99226,033

0

20,000

40,000

60,000

80,000

100,000

120,000

93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01 01-02 02-03 03-04 04-05 05-06Academic Year

No

. of

Re

sid

en

ts

All residents First-year

Number of Residents in U.S. Allopathic Training Programs According to the Type of

Medical School Attended from 1993-2003 (Source: AMA)

70,21867,524 68,647 66,893 67,111 67,085 67,316 65,820 65,661 66,646 67,131 68,465 68,578

3,296 3,264 3,333 3,288 3,367 3,678 3,869 4,175 4,658 5,327 5,838 5,675 6,474

23,291 24,079 25,601 25,257 26,102 25,981 26,414 24,707 25,403 25,783 26,577 27,133 28,022

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01 01-02 02-03 03-04 04-05 05-06

Academic Year

No.

of R

esid

ents

U.S. allopathic U.S. osteopathic Foreign

219,897259,443

323,799

453,165

601,237

776,301

906,278 988,100

299.2297.4277.4

236.9

195.9

155.6

141.6142.2

0

200,000

400,000

600,000

800,000

1,000,000

1950 1960 1970 1980 1990 2000 2010 2020

Su

pp

ly (

Th

ou

sa

nd

s)

Supply of Active Physicians (MD & DO) and Ratio to Population Actual 1950-1990 and

Projected 2000-2020Physicians Per

100,000 PopulationPopulation is U.S. civilian

population including possessions

Title VII Appropriations 1964-2007

$0

$250

$500

$750

$1,000

$1,250

$1,500

$1,750

$2,000

$2,250

$2,500

$2,750

64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 00 02 04 06

Mill

ion

s

Year

Actual Appropriation

Appropriation Adjusted forCPI (2006)

Title VII and Medicare GME (2006 dollars)

$0$1$2$3$4$5$6$7$8$9

$10

Billio

ns

Total GME

IME

DME

Title VII

Characteristics of Physician Workforces of US, UK, Canada, and Australia.

Country Physicians per 100,000 population

% IMGs in MD workforce(total IMGs)

% IMGs from lower income countries

% IMGs from other three countries

US 293 25.0 (208,733) 60.2 6.5

UK 231 28.3 (39,266) 75.2 2.5

Canada 220 23.1 (15,701) 43.4 22.3

Australia 271 26.5 (14,346) 40.0 33.5

G. Anderson et al.

Health Affairs, 25, no. 3 (2006)

Current Questions

• More Medical Schools?

• More Residents?

• More Medicare GME?

• More/less physicians from abroad?

• Would more doctors make America healthier…happier…richer…poorer?