Exploring the Workforce Implications of a Decade of Medical School Expansion

Shipman, Scott A.; Jones, Karen C.; Erikson, Clese; Sandberg, Shana F.

doi:10.1097/acm.0000000000000040

Cited by 22 publications

(4 citation statements)

References 30 publications

(25 reference statements)

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“…However, similar to Australia, in the US there has been a large scale expansion of medical student numbers. A comparison of graduates from the pre-expansion period 1999–2001 with those from 2009–2011 post-expansion [29] indicated that those medical schools with the most expansion over the decade have produced the highest proportion of physicians practicing in underserved and rural areas. Much of this may relate to the opportunities taken during expansion to target greater recruitment of students from minorities and from underserved areas.…”

Section: Discussionmentioning

confidence: 99%

Impact of medical student origins on the likelihood of ultimately practicing in areas of low vs high socio-economic status

2017

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IntroductionMedical schools are in general over-represented by students from high socio-economic status backgrounds. The University of Western Australia Medical School has been progressively widening the participation of students from a broader spectrum of the community both through expanded selection criteria and quota-based approaches for students of rural, indigenous and other socio-educationally disadvantaged backgrounds. We proposed that medical students entering medical school from such backgrounds would ultimately be more likely to practice in areas of increased socio-economic disadvantage.MethodsThe current practice address of 2829 medical students who commenced practice from 1980 to 2011 was ascertained from the Australian Health Practitioner Regulation Agency (AHPRA) Database. Logistic regression was utilised to determine the predictors of the likelihood of the current practice address being in the lower 8 socio-economic deciles versus the top 2 socio-economic deciles.ResultsThose who were categorised in the lower 8 socio-economic deciles at entry to medical school had increased odds of a current practice address in the lower 8 socio-economic deciles 5 or more years after graduation (OR 2.05, 95% CI 1.72, 2.45, P < 0.001). Other positive univariate predictors included age at medical degree completion (for those 25 years or older vs those 24 years or younger OR 1.53, 95% CI 1.27, 1.84, P < 0.001), being female (OR 1.26, 95% CI 1.07, 1.48, P = 0.005) and having a general practice versus specialist qualification (OR 4.16, 95% CI 3.33, 5.19, P < 0.001). Negative predictors included having attended an independent school vs a government school (OR 0.77, 95% CI 0.64, 0.92, P < 0.001) or being originally from overseas vs being born in Oceania (OR 0.80, 95% CI 0.67, 0.96, P = 0.017). After adjustment for potential confounders in multivariate logistic regression, those in the lower 8 socio-economic deciles at entry to medical school still had increased odds of having a current practice address in the lower 8 socio-economic deciles (OR 1.63, 95% CI 1.34, 1.99, P < 0.001).ConclusionWidening participation in medical school to students from more diverse socio-educational backgrounds is likely to increase the distribution of the medical workforce to ultimate service across areas representative of a broader socio-economic spectrum.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0842-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Impact of medical student origins on the likelihood of ultimately practicing in areas of low vs high socio-economic status

2017

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“…It is therefore unclear whether it was the retreat from managed care of the late 1990s or the failure of managed care to resolve the critical market failures involved that explains the persistent imbalance 20 years later. The continued imbalance between generalists and specialists remains well documented by, for example (Julian, Riegels and Baron 2011;Hing and Schappert 2012;Shipman et al 2013 ) despite the expected pressures of recent U.S. reforms on primary care systems (Long 2008;Long and Massi 2009). 1 The extent to which market forces discipline the tendency of medical education systems in other parts of the world to overproduce specialists varies.…”

Section: The Market For Health Professional Education C H a P T E Rmentioning

confidence: 99%

The Economics of Health Professional Education and Careers: Insights from a Literature Review

McPake¹,

Squires²,

Mahat³

et al. 2015

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Some rights reserved 1 2 3 4 18 17 16 15 World Bank Studies are published to communicate the results of the Bank's work to the development community with the least possible delay. The manuscript of this paper therefore has not been prepared in accordance with the procedures appropriate to formally edited texts. This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Nothing herein shall constitute or be considered to be a limitation upon or waiver of the privileges and immunities of The World Bank, all of which are specifically reserved.

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“…Due to a payment cap on Medicare-supported residencies that the US Congress imposed in the Balanced Budget Act of 1997, US medical education enrollments have grown faster in recent years than GME positions [ 76 – 77 ]. The opening of 16 new US MD-granting schools matriculating their inaugural classes since 2002, and the expansion of first-year enrollments in existing US medical schools have contributed significantly to this growth [ 78 – 79 ]. If these trends persist, the number of residency slots available to IMGs will decrease significantly and competition to match to specialties will be even fiercer.…”

Section: Discussionmentioning

confidence: 99%

Monitoring Sub-Saharan African Physician Migration and Recruitment Post-Adoption of the WHO Code of Practice: Temporal and Geographic Patterns in the United States

2015

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Data monitoring is a key recommendation of the WHO Global Code of Practice on the International Recruitment of Health Personnel, a global framework adopted in May 2010 to address health workforce retention in resource-limited countries and the ethics of international migration. Using data on African-born and African-educated physicians in the 2013 American Medical Association Physician Masterfile (AMA Masterfile), we monitored Sub-Saharan African (SSA) physician recruitment into the physician workforce of the United States (US) post-adoption of the WHO Code of Practice. From the observed data, we projected to 2015 with linear regression, and we mapped migrant physicians’ locations using GPS Visualizer and ArcGIS. The 2013 AMA Masterfile identified 11,787 active SSA-origin physicians, representing barely 1.3% (11,787/940,456) of the 2013 US physician workforce, but exceeding the total number of physicians reported by WHO in 34 SSA countries (N = 11,519). We estimated that 15.7% (1,849/11,787) entered the US physician workforce after the Code of Practice was adopted. Compared to pre-Code estimates from 2002 (N = 7,830) and 2010 (N = 9,938), the annual admission rate of SSA émigrés into the US physician workforce is increasing. This increase is due in large part to the growing number of SSA-born physicians attending medical schools outside SSA, representing a trend towards younger migrants. Projection estimates suggest that there will be 12,846 SSA migrant physicians in the US physician workforce in 2015, and over 2,900 of them will be post-Code recruits. Most SSA migrant physicians are locating to large urban US areas where physician densities are already the highest. The Code of Practice has not slowed the SSA-to-US physician migration. To stem the physician “brain drain”, it is essential to incentivize professional practice in SSA and diminish the appeal of US migration with bolder interventions targeting primarily early-career (age ≤ 35) SSA physicians.

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Exploring the Workforce Implications of a Decade of Medical School Expansion

Abstract: Despite expansion, the characteristics of matriculating medical students changed little, except at new schools. Further expansion may benefit from targeted consideration of workforce needs.

Cited by 22 publications

References 30 publications

Impact of medical student origins on the likelihood of ultimately practicing in areas of low vs high socio-economic status

Impact of medical student origins on the likelihood of ultimately practicing in areas of low vs high socio-economic status

The Economics of Health Professional Education and Careers: Insights from a Literature Review

Monitoring Sub-Saharan African Physician Migration and Recruitment Post-Adoption of the WHO Code of Practice: Temporal and Geographic Patterns in the United States

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