The U.S. Physician Workforce:
Beyond the Numbers
Fitzhugh Mullan, MD
The George Washington University
National Health Policy Conference
February 13, 2007
Physician Workforce History:
Key Dates
• 1963 – Enactment of the Health Professions
Education Assistance Act
– Construction, Scholarships, Capitation $$$
• 1964 – Civil Rights Act
• 1971 – Reauthorization of the HPEA
– NPs and PAs
– AHECs
• 1976 – Reauthorization of the HPEA
– Funding significantly decreased
– PC and underservice added as priorities
Key Dates II
• 1980 – GMENAC Report
– Predicted substantial MD surpluses
• 1983 – Medicare PPS Implemented
– DME and IGME payments begun
• 1992-1994 – Health Care Reform Debate
– GME funding linked to workforce goals
proposed...unsuccessfully
• 1994 – COGME Calls for 50-50/110
Key Dates III
• 1997 – Balanced Budget Amendment
– Caps Medicare funded residency slots
• 2005 – COGME Calls for 15% Increase in
Medical Student Enrollment
• 2006 – AAMC Calls for 30% Increase in
Medical Student Enrollment
• 2007 – Title VII Slated for Elimination
What Happened
• Medical Schools Increased from 87 in
1965 to 126 in 1980
• Graduates Increased from ~8,000/yr in
1965 to ~16,500/yr in 1980
• From 1980 to the present graduates
have remained at ~16,500/yr
• Osteopathic Schools have grown
steadily from 5 to 20 now graduating
~3000/yr
What Happened II
• Residents grew from ~60,000 in 1965 to
~100,000 in 1992 and have remained at
that level
• IMGs have grown from ~10% of
residents to ~25% of residents…and
25% of practicing physicians today
Applicants to Allopathic Medical Schools and Enrollment
(Source: AMA)
Year
No. of
Applicants
No. Accepted
Applied:
Accepted
Ratio
No. Enrolled
Mean GPA of
Applicants
1980
36,100
17,146
2.1
16,590
3.32
1992
37,408
17,464
2.1
16,289
3.24
1993
42,808
17,362
2.5
16,307
3.26
1994
45,364
17,317
2.6
16,287
3.28
1995
46,591
17,357
2.7
16,253
3.31
1996
46,967
17,385
2.7
16,201
3.34
1997
43,018
17,313
2.5
16,165
3.38
1998
40,998
17,374
2.4
16,170
3.40
1999
38,449
17,424
2.2
16,221
3.43
2000
37,092
17,538
2.1
16,301
3.44
2001
34,859
17,456
2.0
16,365
3.45
2002
33,625
17,592
1.9
16,488
3.46
2003
34,786
17,539
2.0
16,538
3.47
2004
35,735
17,662
2.0
16,648
3.47
2005
37,373
17,987
2.1
17,003
3.48
2006
39,108
18,442
2.1
17,370
3.48
Number of Residents in U.S. Allopathic
Training Programs from 1993-2003 (Source: AMA)
All residents
120,000
No. of Residents
100,000
97,370 97,832
98,035
98,076
98,143
First-year
97,383
97,989
96,806
96,410 98,258
99,964 101,291 103,106
80,000
60,000
40,000
20,000
26,033 25,992
24,170
24,608
24,516 24,571
25,498
24,681 23,034
23,443
23,922
23,789
25,737
0
93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01 01-02 02-03 03-04 04-05 05-06
Academic Year
Number of Residents in U.S. Allopathic
Training Programs According to the Type of
Medical School Attended from 1993-2003
(Source: AMA)
80,000
U.S. allopathic
U.S. osteopathic
Foreign
70,000
No. of Residents
60,000
70,218
67,524
68,647
66,893
67,111
67,085
67,316
65,820
65,661
66,646
67,131
68,465
68,578
25,601
25,257
26,102
25,981
26,414
24,707
25,403
25,783
26,577
27,133
28,022
23,291
24,079
3,296
3,264
3,333
3,288
3,367
3,678
3,869
4,175
4,658
5,327
5,838
5,675
6,474
93-94
94-95
95-96
96-97
97-98
98-99
99-00
00-01
01-02
02-03
03-04
04-05
05-06
50,000
40,000
30,000
20,000
10,000
0
Academic Year
Supply of Active Physicians (MD & DO) and
Ratio to Population Actual 1950-1990 and
Projected 2000-2020
Physicians Per
100,000 Population
1,000,000
297.4
299.2
277.4
Population is U.S. civilian
population including
possessions
906,278
988,100
2010
2020
236.9
776,301
800,000
Supply (Thousands)
195.9
601,237
155.6
600,000
142.2
141.6
400,000
453,165
323,799
219,897
259,443
200,000
0
1950
1960
1970
1980
1990
2000
Title VII Appropriations 19642007
Millions
Actual Appropriation
Appropriation Adjusted for
CPI (2006)
$2,750
$2,500
$2,250
$2,000
$1,750
$1,500
$1,250
$1,000
$750
$500
$250
$0
64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 00 02 04 06
Year
19 6
4
19 6
5
19 6
6
19 6
7
19 6
8
19 6
9
19 7
0
19 7
1
19 7
2
19 7
3
19 7
4
19 7
5
19 7
6
19 7
7
19 7
8
19 7
9
19 8
0
19 8
1
19 8
2
19 8
3
19 8
4
19 8
5
19 8
6
19 8
7
19 8
8
19 8
9
19 9
0
19 9
1
19 9
2
19 9
3
19 9
4
19 9
5
19 9
6
19 9
7
19 9
8
19 9
9
20 0
0
20 0
1
20 0
2
20 0
3
20 0
4
20 0
5
20 0
6
20 0
7
Billions
Title VII and Medicare GME
(2006 dollars)
$10
$9
$8
$7
$6
$5
$4
$3
$2
$1
$0
Total
GME
IME
DME
Title VII
Characteristics of Physician Workforces of
US, UK, Canada, and Australia.
Country
Physicians
per 100,000
population
% IMGs in
MD
workforce
(total IMGs)
% IMGs
from lower
income
countries
% IMGs
from
other three
countries
US
293
25.0 (208,733)
60.2
6.5
UK
231
28.3 (39,266)
75.2
2.5
Canada
220
23.1 (15,701)
43.4
22.3
Australia
271
26.5 (14,346)
40.0
33.5
G. Anderson et al.
Health Affairs, 25, no. 3 (2006)
Current Questions
• More Medical Schools?
• More Residents?
• More Medicare GME?
• More/less physicians from abroad?
• Would more doctors make America
healthier…happier…richer…poorer?