Analysis

Expanding the US medical workforce: global perspectives and parallels

BMJ 2007; 335 doi: 10.1136/bmj.39246.598345.94 (Published 2 August 2007)
Cite this as: BMJ 2007;335:236

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  1. Jonathan P Weiner, professor of health policy and management
  1. Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
  1. jweiner{at}jhsph.edu
  • Accepted 19 May 2007

America's medical schools are gearing up for their biggest expansion in decades. But Jonathan P Weiner argues that more doctors is not the answer to the country's healthcare problems and calls for a more international approach

The American medical education community has reached a consensus that a shortage of doctors is looming. Several years of heated discourse, dominated by current and former medical school deans, culminated in an influential position paper by the American Association of Medical Colleges (AAMC) calling for an urgent and immediate expansion of US medical students by 30%.1

The arguments for expansion have been discussed fully elsewhere,2 3 4 5 They include the belief that patients will soon want and need more services than the current stock of doctors can provide, newly trained doctors will be unwilling or unable to see as many patients each week as in the past, and the US should not be so reliant on doctors trained abroad. But is there really a problem?

US workforce supply

The supply of US doctors has grown faster than the patient population for many decades (fig 1⇓). The proportion of doctors that are generalists has been falling fast. The ever growing importance of specialists in the US, and the plummeting popularity of primary care among new medical graduates has been understandably disquieting to the primary care specialty societies.6 7

Fig 1 Actual and forecasted US non-trainee doctors (MD and DO degrees) per 100 000 population, 1975-2015 (American Medical Association, American Osteopathic Association, 2006).4 Primary care includes family physicians, general internal medicine, and paediatrics

The pipeline for new American medical practitioners is multifaceted (box 1). Although the output of programmes training medical doctors has been level over the past few decades, schools training nurse practitioners, physicians assistants, and doctors of osteopathy (a uniquely American qualification) …

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