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Intro -- FrontMatter -- Reviewers -- Foreword -- Acknowledgments -- Contents -- Boxes, Figures, and Tables -- Summary -- 1 Introduction -- 2 Background on the Pipeline to the Physician Workforce -- 3 GME Financing -- 4 Governance -- 5 Recommendations for the Reform of GME Financing and Governance -- Appendix A: Abbreviations and Acronyms -- Appendix B: U.S. Senate Letters -- Appendix C: Public Workshop Agendas -- Appendix D: Committee Member Biographies -- Appendix E: Data and Methods to Analyze Medicare GME Payments -- Appendix F: Illustrations of the Phase-In of the Committee's Recommendations.
Enormous changes are occurring in the organization and financing of the U.S. health care systemâ€"rapid changes that are being driven by market forces rather than by government initiatives. Although it is difficult to predict what they system will look like once it begins to stabilize, the changes will affect all components of the health care workforce, and the numbers and types of health care professionals that will be needed in the futureâ€"as well as the roles they will fillâ€"will surely be much different than they were in the past. Despite numerous studies in the past 15 years showing that we might have more doctors than we need, the number of physicians in residency training continues to grow. At the same time, there is evidence that the demand for physician services will decrease as a result of growth of managed care. All of this is evidence that the demand for physician services will decrease as a result of growth of managed care. All of this is taking place at a time when, coincident with the result of failure of comprehensive health care reform, there is no coordinated and widely accepted physician workforce policy in the United States. The present study examines the following three questions: (1) Is there a physician policy in the United States? (2) If there a surplus, what is its likely impact on the cost, quality, and access to health care and on the efficient use of human resources? (3) What realistic steps can be taken to deal with a physician surplus? December
Doctors in a Strange Land provides an in-depth analysis of rural America's reaction to, and acceptance of, the international medical graduates who have come to live and work in their towns. Leonard Baer's study draws on case studies of two small, rural communities to identify who the immigrant physicians are and investigate how well they have been received. His research findings reveal complex issues of race, gender, religion, and language that are of great significance to the ongoing national debate about the place of immigrant physicians.
Graduate medical education (GME) is critical to the career development of individual physicians, to the functioning of many teaching institutions, and to the production of our physician workforce. However, recent reports have called for substantial reform of GME. The current lack of established GME outcome measures limits our ability to assess the impact of individual graduates, the performance of residency programs and teaching institutions, and the collective contribution of GME graduates to the physician workforce. To examine the opportunities and challenges in measuring and assessing GME outcomes, the National Academies of Sciences, Engineering, and Medicine held a workshop on October 10â€"11, 2017, in Washington, DC. Workshop participants discussed: meaningful and measurable outcomes of GME; possible metrics that could be used to track these GME outcomes; possible mechanisms for collecting, collating, analyzing, and reporting these data; and further work to accomplish this ambitious goal. This publication summarizes the presentations and discussions from the workshop.