On June 9, 2015, Steven J. Stack, MD, FACEP, was sworn in as President of the American Medical Association (AMA)—the first emergency physician to hold that office. Dr. Stack recently spoke with ACEP Now Medical Editor-in-Chief Kevin Klauer, DO, EJD, FACEP, about the projected physician shortage, the role of advanced practice providers, and how he developed his speaking skills.
Dr. Kevin Klauer: What are your thoughts on where the AMA thinks the physician shortage is going and what it might be able to do to impact that? As a related question, has the AMA really taken a position on advanced practice providers, such as advanced practice nurses who are pushing for autonomous practice? There are physicians who are threatened by that in particular when there are initiatives to have advanced practice nurses who have completed doctoral programs claim the title of doctor.
Dr. Steven Stack: There are three parts here. The first one is there is a physician shortage. The physician shortage will get worse, and it’s unacceptable. Apart from the other explanations in the system, there is a dire need for more doctors, real doctors, physicians, and doctors of osteopathic medicine. I believe it was the Association of American Medical Colleges that just came out with a research piece that projected—even in a rosy case scenario where other clinicians, nurse practitioners (NPs), physician assistants (PAs), and others play a bigger role—over the next decade a shortage of 45,000 or more physicians.1 That’s even with all of these other clinicians coming into the system and doing more. We’re creating more medical schools, and we’re graduating more medical students, but the federal government is the funder for graduate medical education and residencies, and they refuse to add more money to the pool to create more slots. It’s been frozen for a very long time, and in fact, both parties have introduced cuts to graduate medical education funding. They are not only not adding to it, they are 180 degrees in the wrong direction and ready to cut. Unfortunately, there is no interest from other participants. Thus far, the graduate medical education community has been unable to come up with a new approach to fix that, and it has to be fixed. The AMA, through its advocacy, continues to press for the need to expand residency slots because, in this year’s match we just finished, around 1,100 U.S. medical grads did not match. I’ll give you a story to make that even worse. There are young adults who have graduated from schools like Johns Hopkins, which is ranked as the best medical school in the country most years, who did not match. Now, if you can get into college and get into the best medical school in the United States after college and you can’t match at the end of that, we’ve got a problem. If the smartest people in the nation can’t finish their training and have to go to work at a restaurant waiting tables or drive a taxi to get through their next year while they hope they can match the following year, it’s really a horrible situation. It is utterly unacceptable, but it’s not been easy to find a way to fix that structure. Something every bit as profound as what we’re doing for reforming medical schools will probably need to happen in the residency and fellowship training world, but it’s a difficulty where a path to do so has not yet materialized.