AMA House of Delegates

Physician shortages will get worse under health reform, says Jayesh Shah, MD. Photo by Judy Fidkowski-Tetzlaff

AMA meeting: More physicians needed to counter work force shortages

■ The AMA will push to create more residency slots, promote primary care and expand care in underserved areas.

By Carolyne Krupa — Posted June 28, 2010

Chicago -- The AMA House of Delegates adopted policies aimed at increasing the physician work force and staving off shortages.

The policies call for promoting physician practice in underserved areas, expanding residency training, encouraging more people to become primary care physicians, and addressing a severe shortage of child and adolescent psychiatrists.

Demand for doctors is expected to outpace supply by as many as 159,000 physicians by 2025. At least 22 states and 15 medical specialties have reported physician shortages.

The millions of people who will become insured under the health system reform law will compound the issue, said Jayesh Shah, MD, chair of the AMA International Medical Graduate Section and an undersea medicine specialist from San Antonio. "The shortage is going to get worse with the health care reform."

An AMA report adopted by delegates urges vigilance in seeking funding from a variety of sources for more residency slots.

"This is a very, very important report on an extremely important issue," said New York internist Michael Reichgott, MD, PhD, a delegate for the AMA Section on Medical Schools.

While medical school enrollment has climbed 2% annually over the past five years through new schools and expansion of existing schools, the number of residency slots funded by Medicare has been capped at about 100,000 since 1997. The health reform law calls for redistribution of unused residency positions and more federal funding equivalent to about 300 new training slots, but that's "far below what the population growth and aging population will require," the AMA report said.

To encourage more people to become primary care physicians, the AMA will work with other agencies, and federal and state governments, to promote community-based training and care models.

The Dept. of Health and Human Services on June 16 announced $250 million to strengthen primary care, including $168 million to create more primary care residency slots. The money is expected to help train more than 500 primary care physicians by 2015.

David Fassler, MD, an alternate delegate for the American Academy of Child & Adolescent Psychiatry, which represents 7,400 child and adolescent psychiatrists, said the specialty has been hit hard by physician shortages. Delegates adopted policy calling for the AMA to work with federal agencies to train more people in the specialty through the National Health Service Corps.

Delegates approved a report that says medical schools and residency programs should develop policies to attract students to practice in rural and underserved areas. J.L. Lawson, MD, a general surgeon and an Arkansas Medical Society delegate from Cammack Village, said most medical schools are in metropolitan areas where graduates want to stay. "Most don't appreciate the ability to practice in underserved, rural areas," he said.

The AMA will work with the Centers for Medicare & Medicaid Services and other organizations to develop training programs outside hospitals. "The predominance of our health care is now being provided away from the hospital," said Kosciusko, Miss., family physician Tim Alford, MD, president of the Mississippi State Medical Assn. "The training and money for training is not following that."

ADDITIONAL INFORMATION

Meeting notes: Medical education

Issue: The National Board of Medical Examiners in 2008 made an agreement with the Council for the Advancement of Comprehensive Care to license questions for doctor of nursing practice certification exams originally used on the U.S. Medical Licensing Examination. Subsequent communications suggested equivalency between the exams.

Proposed action: Oppose and continue to monitor use of USMLE questions for purposes other than assessing physicians or physicians-in-training, and work with the NBME to ensure that communications clarify the difference between certification and licensure exams. [Adopted]

Issue: More international medical graduates are seeking residency or fellowship training in the U.S. under H-1B or J-1 visa programs that restrict their time in the country.

Proposed action: Continue to monitor physicians under nonimmigrant visas who cannot finish residency or fellowship training within visa time restrictions; reaffirm AMA's stance that state medical boards should not use an IMG's medical school as a basis of denying licensure. [Adopted]

Issue: The Conrad 30 J-1 visa waiver program allows international medical graduates to stay in the U.S. rather than return to their home countries for two years after completion of residency or fellowship training. Physicians in the program are vulnerable to abuse by visa-sponsoring employers.

Proposed action: Support development of a model employment contract to protect the rights of J-1 visa waiver physicians. [Adopted]

Issue: A 2008 Institute of Medicine report recommended limiting residents to 16 hours of work without sleep, adding sleep requirements to overnight call, increasing days that residents must be off work and limiting resident moonlighting.

Proposed action: Oppose adoption of the institute's recommendations by the Accreditation Council for Graduate Medical Education, given a lack of evidence linking resident schedules to patient care outcomes, and noting that training differs greatly among various disciplines and thus requires more flexibility. [Adopted]

Issue: Medical school and residency are stressful periods of training. Residents and practicing physicians often lack a regular source of care. Adjustment to the medical school environment, demanding curriculum and exposure to human suffering and death, among other factors, might contribute to a decline in personal and mental health and a deterioration of coping strategies.

Proposed action: Form an expert panel to address the risk factors for suicide across the continuum of medical education and clinical practice, and develop recommendations and solutions to prevent suicide in medical students, residents and practicing physicians. [Adopted]