Graduate Medical Education National Advisory Committee Research Articles

Growing Academic Physiatry: The Impact of the Baruch's Grants on Harvard Medical School and Columbia College of Physicians and Surgeons. Part II.

Growing Academic Physiatry: The Impact of the Baruch's Grants on Harvard Medical School and Columbia College of Physicians and Surgeons. Part II.

A Tale of Two Cities: Evolution of Academic Physiatry in Boston and Baltimore: Part 1: The Boston Marathon

A Tale of Two Cities: Evolution of Academic Physiatry in Boston and Baltimore: Part 1: The Boston Marathon

The GMENAC report and the PA profession.

The 1980 report of the Graduate Medical Education National Advisory Committee (GMENAC) predicted a surplus of physicians by 1990 and 2000. The report appeared to have a depressing effect on the growth of the PA profession in the early 1980s; in the 9 years following its release, no new PA programs were started and a number of existing programs closed. The GMENAC forecast proved to be inaccurate and the PA profession saw significant program growth in the 1990s and beyond. A lesson of GMENAC is that accurately predicting health workforce supply and demand is difficult.

Rethinking cancer clinical trials for the future.

Future OncologyVol. 10, No. 9 OpinionRethinking cancer clinical trials for the futureMatthew D GalskyMatthew D GalskySearch for more papers by this authorPublished Online:22 Aug 2014https://doi.org/10.2217/fon.14.95AboutSectionsView ArticleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinkedInReddit View articleKeywords: accrualcancerclinical trialstelemedicine References1 Murthy VH, Krumholz HM, Gross CP. Participation in cancer clinical trials: race-, sex-, and age-based disparities. JAMA 291(22), 2720–2726 (2004).Crossref, Medline, CAS, Google Scholar2 Stensland KD, McBride R, Wisnivesky JP et al. Premature termination of genitourinary cancer clinical trials. J. Clin. Oncol. 32(Suppl. 4), Abstract 288 (2014).Crossref, Google Scholar3 Kasenda B, von Elm E, You J et al. Prevalence, characteristics, and publication of discontinued randomized trials. JAMA 311(10), 1045–1051 (2014).Crossref, Medline, CAS, Google Scholar4 English R, Lebovitz Y, Griffin R. Transforming Clinical Research in the United States: Challenges and Opportunities: Workshop Summary. The National Academies Press, Washington DC, USA (2010).Google Scholar5 Meropol NJ, Buzaglo JS, Millard J et al. Barriers to clinical trial participation as perceived by oncologists and patients. J. Natl Compr. Canc. Netw. 5(8), 655–664 (2007).Crossref, Medline, Google Scholar6 Kaplan CP, Nápoles AM, Dohan D et al. Clinical trial discussion, referral, and recruitment: physician, patient, and system factors. Cancer Causes Control 24(5), 979–988 (2013).Crossref, Medline, Google Scholar7 Jacoby I. Geographic distribution of physician manpower: the GMENAC (Graduate Medical Education National Advisory Committee) legacy. J. Rural Heal. 7(Suppl. 4), 427–436 (1991).Medline, CAS, Google Scholar8 Ricketts TC. Geographic Methods for Health Services Research: a Focus on the Rural–Urban Continuum. University Press of America, Lanham, MD, USA (1994).Google Scholar9 Galsky MD, Latif A, Stensland KD et al. Distribution and geographic accessibility of prostate cancer clinical trials in the United States. J. Clin. Oncol. 32(Suppl. 4), Abstract 59 (2014).Crossref, Google Scholar10 Breslow MJ. Remote ICU care programs: current status. J. Crit. Care. 22(1), 66–76 (2007).Crossref, Medline, Google Scholar11 PatientsLikeMe. www.patientslikeme.com Google Scholar12 Young LB, Chan PS, Lu X, Nallamothu BK, Sasson C, Cram PM. Impact of telemedicine intensive care unit coverage on patient outcomes: a systematic review and meta-analysis. Arch. Intern. Med. 171(6), 498–506 (2011).Crossref, Medline, Google Scholar13 Breslow MJ, Rosenfeld BA, Doerfler M et al. Effect of a multiple-site intensive care unit telemedicine progr Am. on clinical and economic outcomes: an alternative paradigm for intensivist staffing. Crit. Care Med. 32(1), 31–38 (2004).Crossref, Medline, Google Scholar14 Christensen CM. The Innovator’s Dilemma: When New Technologies Cause Great Firms to Fail. Harper Business, NY, USA (2000).Google Scholar15 Wicks P, Vaughan TE, Massagli MP, Heywood J. Accelerated clinical discovery using self-reported patient data collected online and a patient-matching algorithm. Nat. Biotechnol. 29(5), 411–414 (2011).Crossref, Medline, CAS, Google ScholarFiguresReferencesRelatedDetails Vol. 10, No. 9 eToC Sign up Follow us on social media for the latest updates Metrics Downloaded 79 times History Published online 22 August 2014 Published in print July 2014 Information© Future Medicine LtdKeywordsaccrualcancerclinical trialstelemedicine Financial & competing interests disclosureMD Galsky is supported by a Prostate Cancer Foundation Young Investigator Award. MD Galsky has served as a consultant for Astellas, Dendreon, Jannsen, GlaxoSmithKline and BioMotiv. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.No writing assistance was utilized in the production of this manuscript.PDF download

The United States Cardiovascular Care Deficit

A life so short, a craft so long to learn — Hippocrates, Aphorisms As we move into the new millennium, the deficit of able and willing cardiovascular physician providers widens. In 1980, the Graduate Medical Education National Advisory Committee (GMENAC) predicted an “oversupply of 145 000 physicians in the US by the year 2000.”1 Subsequently, in the early 1990’s, physician workforce analysts used physician staffing patterns at closed panel Health Maintenance Organizations (HMO’s) to predict the number of physicians required per 100,000 population. Based on the HMO model, the predicted physician surplus would exceed 150,000 by the year 2000.2 National major medical organizations responded to these predictions by reducing the number of physician training positions available, particularly in subspecialities such as cardiology, where 12% of fellowship training positions were eliminated between 1995 to 2001.3–5 However, cardiovascular diseases are more prevalent with age, and the US population is growing older. In a recent census, the most rapidly growing decade on a relative basis was that in excess of 80 years old. As older people need more cardiovascular care, who will provide it? Through enhancements in technology and care processes, the mortality due to cardiovascular disease has progressively declined over the past 20 years. This success has allowed the survival of many individuals with chronic cardiovascular disease who require extended care. Remarkably, as the overall burden from cardiovascular disease increases, the supply of qualified individuals to provide care has diminished and threatens to limit access to health care unless remedies are found.6–9 A number of factors contributing to this “cardiovascular care deficit” are eloquently defined and analyzed by Drs W. Bruce Fye, Robert Bonow, and Sidney Smith,10,11 in this issue of Circulation . Their consensus opinion is that the US cardiovascular care deficit will continue to widen …

Estimating Physician Workforce Requirements

Richard Cooper's article in this issue of JAMA titled Perspectives on the Physician Workforce to the Year ignites controversy. 1 Cooper, extrapolating from physician staffing patterns in group- or staff-model health maintenance organizations (HMOs), forecasts the physician surplus to be trivial in the year 2000 and nonexistent by the year 2020 (his Figure 1). He proclaims that the contradiction of his forecast with the reports of the Graduate Medical Education National Advisory Committee (GMENAC) in 1981, 2 Weiner in 1994 and 1995, 3,4 the Council on Graduate Medical Education in 1994, 5 and the Bureau of Health Professions of the US Department of Health and Human Services in 1995 6 is attributable to the use of insupportable assumptions in the other studies. Cooper believes that newer data now available for US population projections, HMO staffing patterns, and physician work effort justify the assumptions he has adopted. See also p

Pediatric Workforce Statement

Developing accurate forecasts for physician workforce needs is an extraordinarily difficult task. In 1980 the Graduate Medical Education National Advisory Committee (GMENAC) completed a comprehensive workforce study. Based on estimates of growth of the number of pediatricians, GMENAC predicted a potential excess of 4950 pediatricians by 1990.1 The American Academy of Pediatrics (AAP) studied the report and issued a response in 1981 that questioned many elements in the model.2 However, the Academy was concerned that an excess number of pediatricians would be produced by the 1990s, and a statement published in 1985 and revised in 1987 recommended government and academic policies ensuring the production of pediatricians of the highest quality, but in fewer numbers.3 Subsequent to the 1987 statement, consistent evidence has pointed to shortages of pediatricians rather than the projected surplus in all regions of the country. A 1990 survey of residency program directors provided the strongest empirical evidence to date that the supply of new pediatricians is not meeting the demand.4 In 1990, the Council on Graduate Medical Education (COGME) contracted with the consulting firm of Abt Associates, Inc to reexamine the adequacy of physician workforce supply. The resulting report, commonly referred to as the Abt report, contends there would be an even greater oversupply of peditricians than projected in the 1980 GMENAC report.5 The AAP concerns with this report's methodology and conclusions were strongly voiced to the COGME and in the literature.6,7 Subsequent to the Abt Report, the COGME published a report which emphasizes a growing shortage of practicing generalists (ie, general pediatricians, general internists, and family physicians) and calls for an increase in the percentage of residents who complete a 3-year training program in the generalist specialties.8

How accurate was GMENAC?--A retrospective review of supply projections for diagnostic radiologists.

In 1982, the Graduate Medical Education National Advisory Committee (GMENAC), a prominent national panel, predicted there would be 25,650 full-time equivalent (FTE) diagnostic radiologists, a 34% oversupply, by 1990. The radiologists involved in GMENAC, however, using models developed by the American College of Radiology, projected 19,800 FTE diagnostic radiologists in 1990, which was similar to the GMENAC estimate of need. The disagreement arose principally from different assumptions about residents entering the specialty. Recent data show there actually were approximately 21,900 FTE diagnostic radiologists in 1990. The radiologists' projection was 10% below this figure; the GMENAC projection was 17% above it. GMENAC erred principally in assuming diagnostic radiology residencies would not replace general radiology residencies, but rather be an addition to them. The radiologists erred principally in their assumption about the effects of the financial problems of hospitals on the number of residency positions. Accurate long-term projection of physician supply in individual specialties may well not be feasible.

Geographic Distribution of Physician Manpower: the GMENAC Legacy*

ABSTRACT: The Graduate Medical Education National Advisory Committee (GMENAC) projected the need for and supply of physicians and other providers, recommended time and access standards for health care services, and developed guidelines for the geographic distribution of physicians. Since this study, analysts have given scant attention to national problems of physician geographic distribution. The issue deserves additional scrutiny in light of the current continuing problems of underservice in rural areas. The emergence of geographic information systems offers a unique opportunity to acquire data on provider distribution and provide a framework for developing and testing redistribution policy.

Geographic Distribution of Physician Manpower: the GMENAC Legacy

The Graduate Medical Education National Advisory Committee (GMENAC) projected the need for and supply of physicians and other providers, recommended time and access standards for health care services, and developed guidelines for the geographic distribution of physicians. Since this study, analysts have given scant attention to national problems of physician geographic distribution. The issue deserves additional scrutiny in light of the current continuing problems of underservice in rural areas. The emergence of geographic information systems offers a unique opportunity to acquire data on provider distribution and provide a framework for developing and testing redistribution policy.

Physician Shortage in Occupational and Environmental Medicine

To determine future training needs for physicians in occupational and environmental medicine based on goals established by the Institute of Medicine (IOM) for clinical practice in the field. A critical review of previously published estimates of the need and supply of physicians with clinical training in occupational and environmental medicine with the application of currently available data to produce revised estimates. Need estimates reviewed from the National Institute for Occupational Safety and Health, the Graduate Medical Education National Advisory Committee (GMENAC), and the Bureau of Health Professions. Supply figures reviewed from GMENAC, the American Medical Association, the American College of Occupational Medicine, and the American Board of Preventive Medicine. Revised need figures are based on the estimated number of occupational and environmental physicians needed to provide adequate nationwide coverage as full-time academic faculty, community-based specialists, and public health physicians in state and local agencies. Revised supply estimates are based on review of available data. Need is estimated at 4600 to 6700 physicians (board-certified or eligible or with special competence in occupational and environmental medicine). Supply is estimated at 1200 to 1500. This review identified a deficit of 3100 to 5500 physicians in this newly evolving specialty. In order to address this shortfall in the next decade, graduate specialty training would need to be increased to about 3 to 5 times the current maximum capacity.

No Evidence of an Emerging Physician Surplus

To the Editor.— In a recent article, 1 we analyzed data on changes in physicians' work load and income during the 1980s and concluded that the demand for physicians' services has equaled or exceeded the growth in physician supply. These findings run directly counter to the projections made by the Graduate Medical Education National Advisory Committee (GMENAC) that we would face a large physician surplus by 1990. In an editorial that accompanied our article, Dr Tarlov, 2 who headed the GMENAC study, is sharply critical of our conclusions. Tarlov disputes our finding concerning the sharp rise in physician income on the grounds that survey data from the American Medical Association used in our study are not corroborated by a medical economics survey. He fails to point out, however, that we verified the American Medical Association findings with income tax data gathered by the Internal Revenue Service. The nearperfect agreement between

How Many Physicians Is Enough?

The practical relevance of physician manpower studies relates to the effects of variation in supply on improvements in (1) the availability of services, (2) the outcomes of medical care, including costs and benefits, and (3) the health of the nation. In this issue of<i>JAMA</i>, a frequent contributor to studies on physician supply, William Schwartz, with Daniel Mendelson,¹applies standard economic theory in a secondary analysis of the American Medical Association's data for the years 1982 through 1987. The authors posit that a surplus of physicians is not developing. Their finding contradicts the projections of the Graduate Medical Education National Advisory Committee (GMENAC) made in 1980.²It is questionable, however, that the work of Schwartz and Mendelson provides useful information regarding the adequacy of the physician supply for the 1980s and the 1990s. Schwartz and Mendelson use the American Medical Association's data for 1982 through 1987,³which

Recent Trends in the Recruitment of Child and Adolescent Psychiatrists

Recruitment in child and adolescent psychiatry has long been a concern of the profession. The 1980 report of the Graduate Medical Education National Advisory Committee (GMENAC) identified child psychiatry as the specialty most in need of expansion. Estimates of prevalence of disorders indicate that more child and adolescent psychiatrists are required to meet the patient care needs. Although the number of residents in child and adolescent psychiatry has increased somewhat over the last ten years, it will fall far short of the GMENAC 1990 target of 9,000. Academic units need to increase the number of child and adolescent psychiatry faculty by approximately 30%. Some recommendations are presented to address continuing problems in recruitment.

The adequacy of physician supply in small rural counties.

Prologue: Roughly one-quarter of Americans live in rural areas. Rural Americans share the same basic needs as do urban dwellers, one of the most fundamental of which is the need for health care. There is growing attention on the rural health scene, including the health status of rural residents, the status of rural hospitals, and the numbers of physicians that choose to practice in rural areas. In this article, David Kindig and Hormoz Movassaghi examine physician supply in small rural counties—those having fewer than 10,000 residents. Over the period 1975–1985, they find, the number of physicians per 100,000 residents grew almost three times faster for the entire United States than for rural areas, despite overall growth in supply. “To consider this [issue],” they state, “we must have some standard or norm of availability that is desired or optimal for these locations. To our knowledge, no such standard exists.” Kindig, who received his medical degree and a doctorate in experimental pathology from the University of Chicago, is professor of preventive medicine and director of programs in health management at the University of Wisconsin, Madison, School of Medicine. His interest in physician supply began when he was president of the American Medical Student Association in the late 1960s, during a time when issues of distribution of physicians across the country first reached the national consciousness. As deputy director of the Bureau of Health Manpower, under the Department of Health, Education and Welfare, from 1974 to 1976, he helped to develop legislation that led to the formation of the Graduate Medical Education National Advisory Committee (GMENAC) and its landmark findings. Movassaghi is currently an assistant professor of finance at the School of Business, Ithaca College, Ithaca, New York. He holds a master of business administration degree and a master's degree in health administration from the University of Wisconsin, Madison, where he was a research assistant at the time this paper was completed.

Reimbursement trends in clinical oncology: payment and quality issues.

AbstractThe 1980 Graduate Medical Education National Advisory Committee (GMENAC) study projected that by the year 1990 a shortage of 700 “hematologists/oncologists” would exist in this country (1). Subsequent estimates indicate manpower needs will be met by certified specialists and, if one includes noncertified specialists a surplus will exist in the near future (2). In addition to increased competition for patients, oncologists face changes in traditional third-party and governmental reimbursement policies as well as the proliferation of such managed care systems as health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Such changes are altering the amounts, timeliness, and methods of physician reimbursement. Aside from concerns about personal payment, oncologists may wonder if such changes will affect the quality of patient care. This article discusses methods of payment for the oncologist's services and the implications that changes in the current system may have on quali...

Beyond GMENAC--another physician shortage from 2010 to 2030?

Since publication of the 1981 report of the Graduate Medical Education National Advisory Committee (GMENAC),1 much attention has been focused on the current and future supply of physicians in the United States. The following analysis will suggest that the policy debate over the supply of physicians has been shortsighted and that important demographic, social, and economic shifts between now and the year 2010 could affect the supply of doctors dramatically, resulting in a shortage. The GMENAC report suggested that by the year 2000 there will be 144,700 too many physicians, or a ratio of 247 doctors to every 100,000 persons, . . .

Assessing a methodology for physician requirement forecasting. Replication of GMENAC's need-based model for the pediatric specialty.

Methodologies for determining levels of U.S. physician requirement are as complex as they are controversial. One long-standing controversy surrounds the advantages of an epidemiologic need-based forecasting model over an economic demand-based model. This paper examines the need-based requirement approach as recently developed by the Graduate Medical Education National Advisory Committee (GMENAC). This approach is assessed for the pediatric specialty by replicating the original model using data derived from three large HMOs. These data were empirically obtained from the computerized visit records of more than 10,000 children at each of the three plans and normatively from Delphi panels consisting of pediatric practitioners at those same sites. Results indicate that if U.S. pediatrician requirement was estimated on the basis of HMO practice data, rather than GMENAC's national ideals, fewer physicians would be needed. The pediatric requirement based on local Delphi panel judgments was lower still, due in great part to the suggestion of increased delegation rates to nonphysician providers. Implications of this comparative analysis for the GMENAC need-based methodology and future physician requirement modeling efforts are discussed.

The projected physician surplus reevaluated.

Prologue: Almost two decades ago, the Carnegie Commission on Higher Education declared in a report, “The most serious shortages of professional personnel in any occupation group in the United States are in health services.” In the ensuing years, Congress sharply increased the federal investment in health professional education and, as a result, bolstered the total supply of providers in a spectacular fashion. Now, the conventional wisdom holds that the United States has more physicians than it can afford to support. In this paper, Steven Jacobsen and Alfred Rimm challenge this view held by the Reagan administration and, increasingly, by the American Medical Association (AMA). A Commentary in this issue by Ruth Hanft also questions the notion that America has a physician surplus, to which the leaders of the AMA and the Association of American Medical Colleges (AAMC) respond. Here Jacobsen and Rimm reassess the supply predictions of the Graduate Medical Education National Advisory Committee (GMENAC), adjusting them for changing practice patterns, growing numbers of women entering medical training and practice, new medical school enrollment trends, and number of foreign graduates that continue to enter residency in this country. Their results differ greatly from GMENAC's predictions. Jacobsen, a student of biostatistics and medicine at the Medical College of Wisconsin, is currently pursuing doctoral studies in epidemiology at the University of Illinois in Chicago. Rimm, also of the Medical College of Wisconsin, is a biostatistician and an epidemiologist certified by the American College of Epidemiologists. He holds a doctorate in agriculture and quantitative genetics from Rutgers University, and his background encompasses a wide variety of epidemiological studies, including chemotherapeutic clinical trials at the Roswell Park Cancer Memorial Institute in Buffalo, New York during the 1960s. Currently he is serving on a Health Care Financing Administration committee whose purpose is to rank 5,700 hospitals in the U.S. by quality of care. The research upon which this article is based received the Thomas Hale Ham award from the AAMC in October 1986.

Organizing to begin physician manpower planning.

The most comprehensive information to date on physician supply and demand has been provided by the Graduate Medical Education National Advisory Committee (GMENAC).1 The GMENAC projections show a st...