Making Use of Workforce Projections to Inform the Graduate Medical Education Policy Debate in the United States (2014-15)

Investigators: Erin P. Fraher PhD MPP, Andy Knapton MSc

Background: There is intense policy debate over whether the nation should expand graduate medical education (GME) or redistribute existing slots to high-need specialties and geographies.  The recently released Institute of Medicine (IOM) report recommends creating a GME Policy Council to use data and workforce projections to more strategically target the $13 billion public dollars spent on GME annually.  At the same time the IOM report was released, a new physician projection model—The FutureDocs Forecasting Tool—was launched. The model findings suggest that there will be significant shortages of physicians to meet the demand for health care services in some geographic areas while there will be surplus capacity in other geographies.

Objective/Aims: This project used the projections released in the FutureDocs Forecasting Tool to develop scenarios about how GME slots might be redistributed from higher-capacity places to areas where there are not enough physicians to meet the population’s need for healthcare services. The project showed the outcome of redistributing GME slots according to three different scenarios:

1. A modest redistribution of slots that will bring the states and specialties most in shortage up to a lesser level of shortage;
2. A more significant redistribution of slots that will draw from overcapacity states and specialties to address workforce shortages in undercapacity states and specialties; and
3. An expansion of slots by 30,000 to be distributed according to the methodology described in the Resident Physician Shortage Reduction Act of 2013.

Methods: The number of visits in shortage/surplus for each type of health care service were derived using the FutureDocs Forecasting Tool. The model’s plasticity matrix was used to translate shortage/surplus visits into the specialty types of physicians who provide these visits in different states.

Policy Relevance: This project demonstrates how workforce projections can be used to inform policy decisions regarding GME investments. The project identified the geographies and specialties that should be targeted for GME expansions and showed how this expansion could be accomplished by redistributing existing GME positions rather than increasing the total number of positions.

• Holmes GM, Fraher EP. Developing Physician Migration Estimates for Workforce Models. Health Serv Res. 2017 Feb;52 Suppl 1(Suppl 1):529-545. 
• Fraher EP, Knapton A, Holmes GM. A Methodology for Using Workforce Data to Decide Which Specialties and States to Target for Graduate Medical Education Expansion. Health Serv Res. 2017 Feb;52 Suppl 1(Suppl 1):508-528.

• Fraher E, Knapton A, Holmes M. A Methodology for Using Workforce Data to Decide which Specialties and States to Target for GME Expansion. Policy Brief. April 2016.

• Fraher EP. Toward a National Strategic Plan for GME: Stakeholders, Data and Innovative State Approaches. Presentation, COGME. April 7, 2016. Rockville, MD.