A NATIONAL-HEALTH WORK-FORCE POLICY

This position paper highlights the need for a national policy for the health work force in general and supports the creation of a national c ommission to better coordinate the supply and distribution of health c are workers to meet the nation's health care needs. It acknowledges th at although there are no definitive data on the optimal mix of physici ans, the nation should at least set a preliminary goal of achieving a 50/50 balance between specialists and generalists. Previous efforts to reverse the trend of decreasing numbers of medical students choosing careers in primary care have failed. A combination of legislative, reg ulatory, and voluntary incentives is now required. A national commissi on should be established to help develop and coordinate federal work f orce policies for the health professions. It would set targets for the aggregate numbers of physicians by specialty and would allocate resid ency and fellowship training positions to match future physician suppl y with requirements. The American College of Physicians emphasizes tha t the commission should be structured to include members, including ph ysicians, who are knowledgable about graduate medical education and th at it should be insulated from political considerations as much as pos sible. Controlling the number of residency and fellowship training pos itions among specialties and linking total postgraduate year-1 positio ns to the output of U.S. medical schools would substantially affect re directing the future supply of physicians. The College offers eight pr inciples for allocating postgraduate training positions. Quality shoul d be the strongest determinant. Local needs and minority representatio n must also be considered. Service needs should not dictate the number of training positions, but special arrangements are necessary to allo w public hospitals in major urban centers to reduce their dependence o n housestaff for meeting patient service needs. The roles and number o f nonphysician health care providers must be considered. Private secto r accreditation bodies such as the Accreditation Council for Graduate Medical Education should recommend allocations of training positions b ased on the quality of training programs. Allocation decisions should be made in advance so that disruptions for programs and residents are minimized. The allocation process, including the national work force c ommission, should be subject to external review.