Publications
Reports
Resource Papers

Meetings

News & Events

About COGME

Members & Staff

Useful Links

Site Index

Finding No. 2:

Problems of access to medical care persist in rural and inner-city areas despite large increases in the number of physicians nationally.

• Access to primary care services is especially difficult in rural and inner-city areas. Many factors contribute to the problems of access, including economic and social circumstances of rural and inner-city areas as well as the shortage of minority and generalist physicians. Minority physicians and physicians in the three primary care specialties (family practice, general internal medicine, and general pediatrics) are more likely to serve inner-city populations.

• Family physicians and general surgeons are more likely than other specialties to serve rural populations. The decline in numbers of general surgeons entering rural practice is little recognized and has significant implications for access to trauma, obstetrical and orthopedic services in rural settings and to the fiscal viability or rural hospitals.

• Consequently, more minority and generalist physicians must be educated and educational programs should specifically address skills needed in these settings. This must be accompanied by sufficient incentives to enter and remain in inner-city and rural practice and by the development of adequate health care systems in which they can practice.

• Access to one important component of primary medical care, obstetrical services, has been in the national spotlight. Problems are greatest in rural and inner-city areas. Causes include economic and sociocultural factors and the availability of obstetricians, family physicians, and nurse midwives. While the total number of obstetricians continues to increase the proportion providing obstetrical services decreases dramatically with the number of years in practice. Less that 10 percent of obstetricians practice in rural settings. Consequently, family physicians historically provide the majority of rural obstetrical care. In recent years, however, the proportion of family physicians providing obstetrical services has also declined markedly. While rising malpractice claims clearly have contributed to the decreasing provisions of obstetrical care, other factors, such as unpredictable hours, also seem to have contributed to these decisions.

Finding No. 3:

The racial/ethnic composition of the Nation's physicians does not reflect the general population and contributes to access problems for underrepresented minorities.

• Although African Americans, Hispanic Americans, and Native Americans compose 22 percent of the total population and will constitute almost one-fourth of all Americans by the year 2000, they represent only 10 percent of practicing physicians, and 3 percent of medical faculty.

• Increasing the percentage of underrepresented minorities in the medical profession is vital as a means of improving access to care and health status of these vulnerable and underserved populations. Minority physicians tend to practice more in minority/underserved areas, reduce language and cultural barriers to care, and provide much needed community leadership.

• Strategies to increase minority enrollment must emphasize increasing and strengthening the applicant pool, the acceptance rate from within this pool, and the student retention rate. These strategies must take into account disproportionately high rates of poverty, poor health status, poor schools, and a continued lack of access to educational and career opportunities. They must include both traditional short-term efforts and long-term strategies targeting younger students early in the education pipeline.

Finding No 4:

Shortages exist in the specialties of general surgery, adult and child psychiatry, and preventive medicine and among generalist physicians with additional geriatrics training.

General Surgery

• The future growth in general surgical services is likely to exceed the growth in the supply of general surgeons. Aging of the U.S. population will increase demand for surgical services and the number of physicians in general surgery is inadequate to meet a growing need for trauma care services and for surgical care in rural areas. The training curricula for general surgery need to be broad-based to ensure that graduates have sufficient knowledge and skills to manage the wide array of surgical problems that may be seen in rural and inner-city areas.

Finding No. 5:

Within the framework of the present health care system, the current physician-to-population ratio in the Nation is adequate. Further increases in this ratio will do little to enhance the health of the public or to address the Nation's problems of access to health care. Continued increases in this ratio will, in fact, hinder efforts to contain costs.

• Efforts to solve problems of access to health care by increasing the total physician supply have been largely unsuccessful. A growing physician oversupply is projected, which will hinder efforts to contain costs. Consequently the number of physicians educated should be reduced. Strategies to improve access to care should, instead, focus on altering the specialty mix, racial/ethnic composition, and geographic distribution of physicians.

Finding No. 6:

The Nation's medical education system can be more responsive to public needs for more generalists, underrepresented minority physicians, and physicians for medically underserved rural and inner-city areas.

• The Nation's system of undergraduate and graduate medical education, taking place in 141 osteopathic and allopathic medical schools and in more than 1,500 institutions and agencies, has responded effectively to many of the Nation's health care needs. During the past 25 years, our Nation's medical education system has responded to public demands to increase the numbers of physicians, advance biomedical research, and develop new medical technology. These responses have resulted in a doubling of the physician supply and the establishment of a biomedical research and medical technology infrastructure that is unsurpassed.

• Today, the medical education system must respond to the Nation's health care and physician workforce needs in the 21st century. These include the need for more primary care research, and increased access to primary care, particularly in underserved rural and urban communities. Changes in the institutional mission, goals, admissions policies, curriculum, faculty composition and reward system, and the site for medical education and teaching are necessary to respond to these needs.

Finding No. 7:

The absence of a national physician workforce plan combined with financial and other disincentives are barriers to improved access to care.

• There is no national physician workforce plan for the United States to meet the current and projected future health care needs of the American people. In addition, there is no coordinated financing strategy and integrated medical education system to implement such a plan. Instead, such critical policy issues as the aggregate physician supply and specialty mix are the result of a series of individual decisions make by the 126 allopathic and 15 osteopathic medical schools and nearly 1,500 institutions and agencies that currently sponsor or affiliate with GME training programs. The medical education financing and health care reimbursement systems create significant disincentives to students who wish to become generalists, physicians who wish practice in underserved areas, and to the provision of basic primary and preventive services to all Americans.

  1   2   3   Page 4