There are more spots in American medical schools, and more new schools starting up to feed the physician supply pipeline. But that gain is unlikely to translate into more practicing doctors because the U.S. capacity for residency programs is staying flat.
That's the summary from the latest annual survey by the American Association of Medical Colleges, which suggests a bottleneck in the system will hold back medical school graduates from getting the residency training they need, says Ed Salsberg, director of AAMC Workforce Studies.
"It's residency training positions that are the driving factors of our supply," he says. Increasing entry positions for GME are growing at less than 1% a year, not enough to meet the expected increase in demand and need for physician services.
According to the survey, the number of medical school enrollees grew from 16,488 in 2002 to 18,390 in 2009 to 20,281 in 2014, a 23% increase. That is augmented by a faster percentage growth in osteopathic student enrollment, from 3,079 in 2002 to 5,104 in 2009 to 6,271 in 2014, a 103% increase from 2001.
By 2018, the report says, medical school enrollment "is on track to reach the 30% targeted increase by 2018."
Salsberg commented that the increase in the number of medical and osteopathic medical graduates coming out of U.S. medical schools are competing with the approximately 9,000 international medical school graduates and non-U.S. osteopath graduates – all applying for residency training positions in the U.S. These programs prefer U.S. MDs, the report said.
"You may get some comfort in the quality side, that (doctors) are coming from well-certified medical schools, but you don't increase the numbers from a workforce planning perspective," he says. "You'll have the likely impact of reducing the number of international graduates and not increasing the total supply."
The AAMC report made these other observations about physician training in the U.S.:
- Between 2002-03 and 2009-10 academic years, 102 of the 125 schools accredited in 2002 (82%) expanded their enrollment reflecting the extensiveness of the response to the call for expansion.
- There are 126 fully accredited medical schools in the U.S., including San Juan Bautista as of early 2010, and six new medical schools have been granted preliminary accreditation for a total of 132. Eight other schools have been designated as "applicant" or "candidate" schools and hope to get the go-ahead to begin enrolling students by 2012. Additionally, media reports in 10 communities in the U.S. that schools were about to be started but no applications have yet been made.
- Of those 132, 12 medical schools told the AAMC they plan to reduce enrollment because of fiscal pressures, and some schools have delayed or postponed plans to expand enrollment.
- Of the schools that responded to the survey saying they were planning to expand, 47 said they were targeting their enrollment to "meet specific missions such as needs in rural and underserved communities as well as to increase diversity."
- Nearly 40% of schools said they were concerned that current economic conditions would challenge their efforts to maintain current enrollment or increase it. Of the 117 schools that responded to the question, 11% reported being "very concerned" regarding the ability to maintain or increase enrollment and 28% reported being "moderately concerned."
Salsberg says that in any case, "increasing the number of doctors is not going to be enough to assure access" for all of the people who will now have some form of health coverage. "Equally important is redesigning the delivery system," he says, and the fact of the matter is that "we're not going to have all the health professionals we might want."
Salsberg says he sees a movement to recognize that nurses and physician assistants may have to pick up some of the load. "We do know the reality is that there are things doctors can do that registered nurses and physician assistants can also do," he says.
Especially given the problem with the obesity epidemic, he says, there may be a growing need for health educators and nutritionists to do provide some of the counseling and care that there won't be enough physicians to provide.