The Council on Graduate Medical Education (COGME) and the Association of American Medical Colleges (AAMC) announced a projected physician workforce shortage in the United States and recommended a 15% increase by the year 2015. This shortage will mainly affect the already underserved populations in rural and urban areas and worsen their access to care, and health disparities. The recent growth of aging populations, retirement rates of practicing physicians, limitation on resident work hours, and an increase in women in medicine are some of the factors that led to this national crisis. The challenge is to re-frame the issue of diversity through this new window of opportunity and raise the level of attention and urgency.
What percentage of this 15% increase in the physician workforce should be minorities?
The United States Office of Management and Budget (OMB) defines race and ethnicity as: 1)Whites; 2)Hispanic/Latino; 3) Black/African American,; 4) American Indian/Alaskan Native; 5) Asian; 6) Native Hawaiian/Pacific Islander,; 7) some other race; and 8) two or more Races.
The AAMC definition of minority physician pre-Gratz and Grutter versus Bollinger uses the term under-represented minority (URM) which includes Blacks/African Americans, Mexican Americans, Native Americans, and Mainland Puerto Ricans.
- To analyze the implications of a 15% increase in the physician workforce in the United States.
- To describe the U.S. physician workforce and the minority physician component.
- To make recommendations to the AAMC regarding the minority physician workforce and its role in the 15% increase in the workforce in the United States.
The AAMC is a non-profit trade association founded in 1876 with three core missions: medical education, medical research, and patient care. They make recommendations to the 125 medical schools, 400 major teaching hospitals, and 94 academic and professional societies in the United States. Their constituents comprise a total of over 270,000 medical professionals representing Chief Executive Officers, Deans, faculty, residents, and medical students. This practicum project is a collaborative effort with the Division of Diversity and Policy Programs.
Secondary analysis of the AAMC’s minority physician database Minority Graduates of U.S. Medical Schools: Trends, 1950-2002 and comparison with the AMA’s Physician Characteristics and Distributions in the U.S., 2004 Edition.
The current practicing physician workforce, including residents and fellows, totals 853,187
This workforce gets approximately 15,000 medical graduates and loses about 25,000 retiring physicians
15% of the medical school graduate class are URM’s
The gender gap is closing in medical school graduates but in the workforce they are 75% male and 25% female
Since 1989, there is a reversal of the gender gap in African Americans
66% of male minority medical graduates are under age 45
79% of female minority medical graduates are under age 45
Twelve-year trends for minority medical graduates choosing primary care:
17% Internal Medicine, 11% Family Medicine, 8% Pediatrics, 5% Ob-Gyn
Twelve-year trends for minority medical graduates choosing subspecialty:
No fellowship entries from 2000-2002 for Cardiovascular, Geriatrics, Oncology
The physician workforce has 5,886 URM’s in Cardiovascular
The physician workforce has 7,252 URM’s in Psychiatry
79% of URM’s are in patient care in an office-based practice type
The top three states to practice for recent medical graduates and practicing physicians are California, New York, and Texas
The highest physician/100,000 population distribution are in the following census divisions: New England (403) and Middle Atlantic (370)
The lowest physician/100,000 population distribution are in the following census divisions: West South Central (225) and Mountain (233)
87% of practicing physicians are located in Metropolitan Statistical Areas (MSA’s) and only 13% in Non-MSA’s.
Minority medical graduates are more likely to have plans to locate their practice in an under-served area.
Conclusions and Recommendation:
The main conclusion from my analysis of data from 1950-2002 is that our medical profession continues to be under-represented with minorities. The populations most likely to feel the detrimental effects of this shortage are the already under-served populations in rural and urban areas. We need to make sure that the increase of 3,000 physicians a year is distributed to these areas to increase access to health care. Since we know that URM’s are currently 6% and are more likely to locate their practice in under-served areas, they should be a significant percentage of the recommended 15% increase in the workforce.
Charles Terrell, EdD, Association of American Medical Colleges
Laura Castillo-Page, PhD, Association of American Medical Colleges