1. Where Have All The Doctors Gone? A Public Health Crisis William H. Harvey, Ph.D. Emeritus Professor of Biology- Advisor/Consultant Earlham College

2. Dramatic increase in MS grads  First year MS enrollment in 2016 will reach 22,000, a 30% increase over 2003 as proposed by AAMC  58% will come from 125 current MS, 25% from 12 new MS and 17% balance from MS in LCME review = 141 total  D.O. enrollment now at 6200 double that of 2003 (number of new schools)  Combined MD and DO enrollment will reach 27,000 an increase of 37% over 2003  This number is approximately equal to the IMG that enter GME each year  Thus approximately 54,000 medical students are in competition for GME

3. Reducing Medicare GME will worsen physician shortage  Proposed GME Medicare cuts (60-70%) – ACA related????  Targets teaching hospitals (6% of all 5,800 hospitals)  These hospitals, about 350, provide 75% of all GME  80% of all ACS certified level 1 trauma centers  28% of all Medicaid inpatient care  40 % of all inpatient charity care

5. Teaching hospitals under financial crisis train tomorrow’s doctors Our nation faces a growing shortage of doctors Our nation faces a growing shortage of doctors By 2015, the shortage will reach 62K in all specialties By 2015, the shortage will reach 62K in all specialties By 2025, the shortage will reach 130K By 2025, the shortage will reach 130K The Medicare population will grow by 36% over next 10 years The Medicare population will grow by 36% over next 10 years 1/3 of physicians will reach 60 and will retire in 10 years 1/3 of physicians will reach 60 and will retire in 10 years

6. Doctor shortfall  In 2008, all specialties = currently 700,000 doctors in practice in N. America  By 2020, demand will approach 900,000 doctors  45,000 too few primary care doctors now  46,000 surgeons and medical specialist shortage now  Total physician shortage in 2020 = 91,500  Impact most severe on vulnerable and underserved pop  Consider implications of a 36% increase in Americans over age 65  Implications of health care demand through the ACA

7. 2013 match left hundreds of applicants without a spot  26,700 residency slots = sum of MD/DO grads  In 2010, MD-94%; DO -71%; IMG – 52% matched  Currently 110,000 residents in training annually  Cost of resident training is $100k/year: Medicare = 40%  Total hospital costs = $13 B: Medicare = $3 B  Approx. 35,000 enter GME annually (Program Year 1)  Additional residency slots over 26,700 are often “subsidized”

9. The New Environment Recent evidence from AAMC about 1000 US grads failed to match last year Recent evidence from AAMC about 1000 US grads failed to match last year Efforts by the AAMC and other academic organizations to increase the net number of new GME positions have not met with success Efforts by the AAMC and other academic organizations to increase the net number of new GME positions have not met with success Matching for the IMG will become increasingly more difficult Matching for the IMG will become increasingly more difficult

10.  Strong Board Scores  Grades and honors  Recommendation letters  Timely submission of materials  Research  Making contact with decision makers (doing an effective rotation)  A good interview  Indicate a commitment to primary care! What does the IMG do to be competitive for these GMEs

11. How can Polish MS address this doctor shortage Recruit and retain strong students Recruit and retain strong students Provide strong academic support in first two years including resources for test prep Provide strong academic support in first two years including resources for test prep Stay informed regarding ACGME residency issues: FREIDA et.al Stay informed regarding ACGME residency issues: FREIDA et.al Provide as much internship opportunities statewide as possible: encourage networking- “observational relationships” critical Provide as much internship opportunities statewide as possible: encourage networking- “observational relationships” critical Attempt to develop new sites for GME training in new hospital sites: this may require some capital investment, “subsidy” Attempt to develop new sites for GME training in new hospital sites: this may require some capital investment, “subsidy” strength in numbers = coalition of Polish MS effort? strength in numbers = coalition of Polish MS effort?

12. Selected references Results of the 2011 Medical School Enrollment Survey: Center for Workforce Studies, May 2012 Results of the 2011 Medical School Enrollment Survey: Center for Workforce Studies, May 2012 AAMC Physician Workforce Policy Recommendations, Sept 2012 AAMC Physician Workforce Policy Recommendations, Sept 2012 Projected Supply and Demand, Physicians, 2008-2020, AAMC Projected Supply and Demand, Physicians, 2008-2020, AAMC Accreditation Council for Graduate Medical Education Accreditation Council for Graduate Medical Education Preserve Medicare Support for Physician Training: AAMC Preserve Medicare Support for Physician Training: AAMC What does Medicare have to do with GME: AAMC What does Medicare have to do with GME: AAMC

13. Thank you for your interest Please call upon me if I can be helpful Please call upon me if I can be helpful Questions? Please come by and introduce yourself! Questions? Please come by and introduce yourself! Again I am: William H. Harvey, Ph.D. Again I am: William H. Harvey, Ph.D. billh@earlham.edu billh@earlham.edu