5 questions that need answers for the future of medical education in the U.S.

Doctors talking
A deep dive into graduate and undergraduate data could help guide the future of medical training in the U.S. (Getty/wmiami)

There are lots of questions when it comes to planning for the U.S. system for training future physicians, says one medical school dean.

And while annual surveys produce updates on undergraduate and graduate medical education in the U.S., there’s little scrutiny and analysis that goes along with it, writes S. Claiborne Johnston, M.D., Ph.D., dean of the Dell Medical School at the University of Texas at Austin, in an editorial in JAMA.

Training future physicians is a huge investment, with the cost for a typical four-year medical school and three-year residency weighing in at almost $1 million, Johnston says.

“Given the size of the investment and its substantial long-term consequences, it is remarkable how little the U.S. system of training has been scrutinized. While other countries dictate the total number of trainees and distribution of specialty positions, the U.S. relies largely on market forces, and for residency and fellowship positions, also relies on specialties to expand or restrict growth,” he writes.

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There’s little commentary, he says, when the American Medical Association (AMA), Liaison Committee on Medical Education (LCME), and the Association of American Medical Colleges (AAMC) produce their annual updates on undergraduate and graduate medical education in the U.S., he says. Both are reported in the same Sept. 11 issue of JAMA.

In total, the survey estimated that there were 130,545 active residents in Accreditation Council for Graduate Medical Education-accredited programs during the 2017-2018 academic year. In the last 10 years, the number of medical students grew from 70,349 to 86,420.

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The data is a starting point to address five questions critical in planning for the U.S. system of medical education, says Johnston, including:

1. Are enough physicians being trained to meet future needs? The AAMC estimates that by 2030 there will be a shortage of between 42,600 and 121,300 physicians in the United States.

2. What is the appropriate role of graduates from osteopathic schools and from non-U.S. medical schools in addressing physician workforce needs?

3. Is there progress in training more primary care physicians? The U.S. already has a shortage of primary care physicians, one that is likely to grow, according to the AAMC. A UnitedHealth Group report (PDF) released this week noted that 13% or 44 million Americans live in a county with a primary care physician shortage, defined as less than one doctor per 2,000 people.

4. Are osteopathic physicians or international medical graduates the answer to the shortage of primary care physicians?

5. How will an increasingly female physician workforce change the profession? The overall incoming class among U.S. medical students in 2017 contains more women than men. That marked a first for the industry.

An understanding of both the current and future status of the physician workforce and training programs would allow for a “more rational” system for training doctors, Johnston says. For example, deans of new medical schools could use the data to plan future programs, and the government could direct subsidies for residency training to areas of need, such as primary care.

The UnitedHealth Group report suggests ways to expand primary care access for patients. Those include the growth of advanced practice clinicians, including nurse practitioners (NPs), physician assistants and certified nurse midwives. Allowing NPs to practice to the full extent of their education and training will also increase primary care capacity, as well as allowing them to practice independently, the report said. NPs are qualified to practice independently in 22 states.

Another solution is the growth of innovative care delivery models, including urgent care centers, retail health clinics and in-home visits, the report said.