April 1997 Bulletin

Urges balance in reduced workforce

NMA backs GME limits, but urges geneder, ethnic diversity

Efforts to slow the growth of the physician work force should also include initiatives to better balance the workforce geographically and to make the work force more diverse, said Randall C. Morgan Jr., MD, president of the National Medical Association (NMA).

The NMA was among six medical associations that endorsed a plan to limit federal funding of graduate medical education (GME) and to eliminate federal programs which allow non-U.S. medical school graduates to remain in the country after completing GME.

The consensus statement was issued February 28 by the Association of American Medical Colleges, American Association of Colleges of Osteopathic Medicine, American Medical Association, American Osteopathic Association, Association of Academic Health Centers and NMA.

'Verge of oversupply'

"It is true that numerous studies over the past decade have produced evidence that the United States is on the verge of an oversupply of physicians," Dr. Morgan said. "Yet, the same data will show that the African-American physician has always been, and continues to be underrepresented in the physician work force of America." He said African-Americans represent about 13 percent of the U.S. population, but less than half that percentage are African-American physicians.

"Another serious concern for the NMA is the challenge to the funding of operations for the hospitals that support the historically black medical schools," Dr. Morgan said. He named Howard University, Meharry Medical College, Morehouse School of Medicine and King-Drew University.

"The educational programs of each of these schools is supported by a major teaching hospital that must survive on public funds," he said. "Each of these hospitals also provides care to a disproportionate amount of patients who are minimally or noninsured."

The NMA requested that arbitrary, across-the-board reductions in funding for GME not be instituted. Instead, the NMA suggests oversight to ensure the proper representation of physicians of all specialties, with no limitations placed on gender or ethnicity.

Duration of residency

Michael Goldberg, MD, chairman of the Academic Orthopaedic Society's graduate medical education (GME) committee, agrees with the proposal by six medical organizations to align the number of GME slots with the number of graduating medical students. However, Dr. Goldberg wants to make sure that the number of GME slots are assured for the duration of the residency.

Funding only the first two or three years of residency, which has been suggested in the past, would reduce the number of specialists such as orthopaedic surgeons, says Dr. Goldberg.

Dr. Goldberg, professor and chairman of the department of orthopaedic surgery, Tufts University and New England Medical Center, also agrees with the proposal of an all-payer fund to finance GME. "Residents should not carry the cost of hospitals on their backs," Dr. Goldberg said. "As the number of hospital beds filled by Medicare patients shrinks, there is a tendency to shrink the number of residents."


The consensus statement issued by the six associations recommended:

The number of entry level positions in the country's GME system should be aligned more closely with the number of graduates of accredited U.S. medical schools by limiting federal funding of GME positions.

The U.S. should continue to provide GME opportunities for foreign-born physicians who have graduated from non-U.S. medical schools, but training should not be financed from Medicare funds currently dedicated for the support of GME, or from any future national all-payer GME fund. These physicians must return to their countries of origin after completing GME in this country.

To increase the likelihood that U.S. medical school graduates will establish practices in traditionally underserved communities, federal funds should be provided to encourage and support medical school efforts to expand the opportunities students have to gain experience in rural and inner city communities.

A national all-payer fund should be established to provide a stable source of funding for the direct costs of GME.

Teaching hospitals that lose resident physicians as a direct result of the reduction in the number of entry level positions in the GME system should receive transitional funds to assist them in establishing alternative methods of delivering services that formerly involved resident physicians.

A national physician work force advisory body should be established to monitor and assess the adequacy of the size and specialty composition of the physician work force in the context of the changing needs of the evolving health care delivery system and evolving patterns of professional practice by non-physician health professionals.

Graduates of surgical residencies since 1987

Surgical specialty 1987 1989 1991 1993 1994
General surgery 1,023 994 995 979 1,001
Obstetrics and gynecology 1,175 1,104 1,133 1,175 1,177
Orthopaedics 620 598 653 630 655
Ophthalmology 512 504 461 465 507
Otolaryngology 257 259 268 271 273
Urology 254 237 254 247 252
Neurological 118 129 110 127 126
Plastic 187 191 204 212 209
Thoracic 135 132 133 144 147
Colon and Rectal 48 49 58 53 54
Vascular 61 69 74 72 78
Pediatrics 17 17 22 21 21

Total 4,407 4,283 4,365 4,396 4,500

Data were obtained from the American College of Surgeons Surgical Resident Masterfile and the
Medical Education Research and Information Database.
© 1993 American Medical Association.

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