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are entered by a physician after they graduate from medical school and determines the area of specialty the physician will pursue and practice throughout their lifetime.
It is estimated that 16,000 physicians enter GME programs each year. (1999) (Miller et al 1999)
“ GME as a societal good”
- Residency or GME has been accepted in most part of society as an essential part of maintaining high quality physician workforce. After earning a medical degree, US physicians are required by law in every state to complete an additional 1 to 3 years of GME before receiving a license to practice medicine (AMA Graduate Medical Directory 1999-2000)
Is there a capacity to absorb the increasing number of Physicians and NPC’s?
“ Heightened competition between physicians and NPC’s seem virtually inevitable in a system that already has an abundant supply of physicians and is intent on overall cost containment” (Editorial, 1998, JAMA 280, 9 pp. 825). (This an opinion from the AMA)
What will be the impact of additional NPC’s on Physician Demand?
This is a complex question influenced by many parameters that requires a better understanding of Physician Services that NPC’s may undertake:
Changes in federal policy toward residency training affect the size and characteristics of the physician workforce.
Economic incentives also play a role in the response of the supply of physicians (ex: the pattern of behavior observed during the late 1960s and the 1970s after the introduction of Medicare, Medicaid, and their precursor programs).
Past Workforce Trends for Physicians and GME (i.e. How did we get here?)
Can be broken down into five areas:
The Post-Flexner Era: 1910 – 1963
The Epoch of Government Blank Checks: 1963 – 1990
The Era of the Wholesale Market for Physician Labor: 1990 – 2000
The Collapse of the Wholesale Market: 2000 – Present
Source: Grumback, Kevin. Fighting Hand to Hand over Physician Workforce Policy . Health Aff 21(5):13-27, 2002. Available at: http://www.medscape.com/viewarticle/440692
Source: Cooper, Richard et al. Economic and Demographic Trends Signal An Impending Physician Shortage , Health Aff., 2002, Vol. 21, No. 1
Future Workforce Trends for Physicians Source: Cooper, Richard et al. Economic and Demographic Trends Signal an Impending Physician Shortage, Health Aff., 2002, Vol. 21, No. 1
Future Workforce Trends for Nonphysician Clinicians
By 2005 it is expected that:
there will be more Chiropractors than general internists
there will be more PAs than general pediatricians
the number of NPs in practice (>115,000) will exceed the number of family physicians, and will exceed by a factor of 2 the number that was predicted to be required for that year by the National Advisory Council on Nurse Education and Practice
Source: Cooper et. al., Current and Projected Workforce of Nonphysician Clinicians, JAMA, September 2, 1998, Vol. 280, No. 9.
This slide originally appeared in a presentation by George Isham, M.D., Chief Health Officer for HealthPartners on May 16 th , 2001.
Major determinate of overall physician surpluses in the future will be the extent to which patients continue to seek physicians for services that will also be offered by nonphysician clinicians.
The CBO determined that any surplus that does arise should be self-correcting over time.
The CBO believes that if the number of physicians were to become excessive, the relative fees and incomes of doctors would fall, the medical profession would become less desirable, and the excess would be eliminated over time.
The additional amount Medicare pays to a teaching hospital equals the hospital's total Medicare diagnosis-related group (DRG) payments for inpatient services multiplied by a factor that is calculated according to a specific mathematical formula
The Government's Prospective Payment Assessment Commission (ProPAC) has suggested that the current IME subsidy be reduced to reflect more accurately those increases in teaching hospitals' costs that are associated with larger resident-to-bed ratios
IME adjustment be reduced in phases from its current rate of about 7.7 percent to 4.5 percent, for a 0.1 increase in the resident-to-bed ratio of the hospital
The doctor could transfer the voucher to a medical group or hospital as part of a contract in which the organization would provide training and a stipend to the resident in exchange for his or her services and payments from the federal government
Specialty boards might be reluctant to consider training at non-hospital sites