docslytherin said:
i've been sitting here wondering about all the new expansion schools opening up lately and wondered what everyone thought about whether or not they're opening too quickly.
on one hand, increasing the population of DOs could be a good move to spread the word about osteopathy and increasing public awareness.
on the other hand, there might be a need to step back and let the AOA work on other issues facing DOs right now. primarily, the lack of DO residencies for the current number of DO grads.
anyway, i was just wondering what others thought... i sometimes fear that we'll saturate the marketplace (much like law schools did in the 80s, so that now there are WAY too many lawyers) though that's a LONG way off... and yes, i do go slightly "chicken little" sometimes.
john
very interesting topic.
there is not likely be a problem of "saturating the market" according to the latest analysis. i just happened to be writing a paper on this physician supply and distribution topic, so see below for details (pasted from my paper) and references.
the osteopathic profession has traditionally (and continues to) churn out lots of primary care physicians who are more likely to serve in areas of need. this is a good thing for the public (contributed positively to the complex equation of access to healthcare). i have pasted some comments from my draft paper.
so - i think that the argument could be made that:
--there's no risk of a physician surplus anytime soon
--DOs, in general, positively contribute to access to care and public good, especially in rural areas which tend to be underserved.
--more DO schools will produce more graduates, which will allow us to help combat the coming shortage that may lead to decreased access to care
--graduates of these DO schools still have to pass the COMLEX or USMLE steps for licensure (the purpose of which is to protect the public by setting standards of competency).
--if a medical school can produce graduates which pass the boards and comparable rates to other schools, but it has a tiny budget and more limited faculty... then perhaps it's just a more cost-effective way to 'produce' the needed increase in physician workforce.
--even though the growth of AOA GME is inadequate to meet the needs of DO graduates - there's still plenty of room to train in ACGME programs. there would likely be an increase in the # of DOs (who currently compose ~ 6% of residents in ACGME programs)and a proportional decrease in IMGs (who currently compose ~ 27% of residents in ACGME programs).
--while the relative decrease in the # of IMGs in ACGME programs would not be apprecaited by those IMGs seeking training in the US, perhaps this is, overall, more "fair". in other words - is it fair from a global perspective for the most economically powerfull nation in the world to utalize physicians from other nations to fill it's physician shortage? many of these physicians are the best and brightest of their nation (this is sometimes called the "brain drain").
**now - having said all of this - do i support opening up more DO schools? i'm not sure. there are other factors to consider here (look for a post later). now for those references:
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The Graduate Medical Education National Advisory Committee (GMENAC), which was established in 1976, concluded that the U.S. would face a surplus of physician in 1981, and reaffirmed this position in several reports published between 1992 and 1998.3 Romano cites COGMEs estimate of a 150,000 physician surplus by 2020.4 Although the physician surplus prediction of GMENAC [which is now known as the Council on Graduate Medical Education (COGME)] did become significant basis for public policy, some in the literature rejected these findings. In an analysis by Cooper et al, it is predicted that while the physician to population ratio will increase to 280 per 100,000 by 2020, there will be a 20% (or 200,000 physician) shortage by this time because of forces that will increase demand for healthcare. While there were those that criticized Coopers findings8,5, Romano cites a study by Salsberg which predicts a 150,000 physician shortage by 20204, and COGME eventually issued a report which acknowledges that there is indeed an impending physician shortage, pegging the number at 85,000 by the same year.10 The projected physician shortage will significantly test the medical education system and do doubt influence interdependent workforce issues, such as the distribution and composition of physicians and non-physician clinicians.
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There is much evidence to suggest that, in general, geographic physician distribution is skewed toward metropolitan areas, leaving those in rural areas with a relative decrease in their access to healthcare. While 20% of the U.S. population resides in rural areas, less than 11% of physicians reside in rural areas.
The Osteopathic profession has had a long history of in rural areas and in primary care specialties. While the profession comprises only 5.1 percent of the nations physicians, DOs make up 15.3 percent of all physicians in small rural counties.17 The West Virginia School of Osteopathic Medicine has had particular success in producing primary care physicians that serve in rural areas. In 1999, 54 percent specialized in family practice, and leads the nation in providing physicians for rural practice in the Appalachian region. 17% percent of graduates from 1989 through 1994 practice in rural areas of West Virginia, compared to an average of only 7% for the two allopathic medical schools in the state.18
There are limits, however, to the above studies, most importantly the fact that not all rural areas are underserved, and not all non-rural areas are not underserved.
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references:
1. Anderson R.M., Rice T.H., Kominski G.F. Changing the U.S. Health Care System. 2nd Ed. 2001. Jossey-Bass.
2. Grumbach K. Fighting Hand To Hand Over Physician Workforce Policy Health Affairs (2002) 21:5;13-27.
3. Salsberg E.S., Forte G.J. Trends In The Physician Workforce 1980-2000 Health Affairs (2002) 21:5;165-173.
4. Romano, M. The Vanishing Doctor Surplus: Fears of looming shortage gain currency in field Modern Healthcare (2003) 33:24;28.
5. Weiner J.P. A Shortage of Physicians or a Surpluss of Assumptions? Health Affairs (2002) 21:1;160-162.
6. Hilsenrath P., Lykens K., Mains D. Physician Supply: An Economic and Policy Perspective Texas Journal of Rural Health (2003) 21:1;16-29.
7. Cooper R.A., et al. Economic and Demographic Trends Signal am Impending Physician Shortage Health Affairs (2002) 21:1;140-154
8. Mullan F. Some Thoughts on the White-Follows-Green Law Health Affairs (2002) 21:1;159-159.
9. Reinhardt U.E. Analyzing Cause and Effect in the U.S. Physician Workforce Health Affairs (2002) 21:1;165-166.
10. Oransky I. Report finds shortage of US physicians by 2020 Lancet (2003) 362:9392;1291.
11. Cooper R.A. Medical Schools and their Applicants: An Analysis Health Affairs (2003) 22:4;71-83.
12. Blumenthal D. Toil and Trouble Gworing physician supply Health Affairs (2003) 22:4;85-87.
13. Wood, D.L. The Physician Workforce: A Medical School Dilemma Health Affairs (2003) 22:4;97-99.
14. Brooks R.G., et al. The Roles of Nature and Nurture in the Recruitment and Reflection of Primary Care Physicians in Rural Areas: A review of the Litreature Academic Medicine (2002) 77;8:790-798.
15. Geyman, et al. Educating Generalist Physicians for Rural Practice The Journal of Rural Health (2000) 16:1;56-80.
16. Tooke-Rawlins D. Rural Osteopathic Family Physician Supply: Past and Present The Journal of Rural Health (2000) 16:3;299-300.
17. Simpson C., Simpson M.A. Complexity of the healthcare crisis in rural America J. American Osteo. Assn. (1994) 94:6;502-508.
18. Stookey J.R., Baker H.H., Nemit J.W., How West Virginia School of Osteopathic Medicine achieves its mission of providing rural primary care physicians America J. American Osteo. Assn. (2000) 100:11;723-726.
