Pathology in a Changing Medical School Landscape

1
Pathology in a Changing Medical School Landscape
Association of Pathology Chairs July 21, 2007
James M. Crawford, M.D., Ph.D. moderator
2
Pathology and the Deathly HallowsPathology in a
Changing Medical School Landscape
Association of Pathology Chairs July 21, 2007
James M. Crawford, M.D., Ph.D. moderator
3
Pathology and the Prisoner of AzkabanPathology
in a Changing Medical School Landscape
Association of Pathology Chairs July 21, 2007
James M. Crawford, M.D., Ph.D. moderator
4
Pathology and the Goblet of FirePathology in a
Changing Medical School Landscape
Association of Pathology Chairs July 21, 2007
James M. Crawford, M.D., Ph.D. moderator
5
Pathology and the Sorcerers StonePathology in
a Changing Medical School Landscape
Association of Pathology Chairs July 21, 2007
James M. Crawford, M.D., Ph.D. moderator
6
The practicing Pathology pool

• Academic Pathology - Clinical (2004) 2,485
• Total Practicing Pathologists (2003) 10,700
• (total ABMS pathologists) 18,300
• Total Practicing Physicians (2001)
  720,000

Academic
Pathology (all)
Pathology
All Physicians
7
The practicing Pathology pool

• Academic Pathology - Clinical (2004) 2,485
• Total Practicing Pathologists (2003) 10,700
• (total ABMS pathologists) 18,300
• Total Practicing Physicians (2001)
  720,000

Academic
Pathology (all)
Pathology
These are our students
All Physicians
8
Factors Influencing Future Physician Supply

• Medical school production (MD, DO)
• International migration and IMG policies
• Aging of physician workforce retirement
• Diversity and minorities
• Gender and generational differences
• Lifestyle choices
• Changing practice patterns
• Productivity changes (efficacy of work)

Total Numbers
Impacts effective supply
Ed Salsberg, AAMC, 2006
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New U.S. Medical Schools

• Arizona MD (Public) Phoenix
• DO (Private) Phoenix (Mesa)
• California MD (Public) Riverside
• Colorado DO (Private) Denver
• Florida DO (Private) Bradenton
• MD (Public) Boca Raton
• MD (Public) Miami
• MD (Public) Orlando
• Georgia DO (Private) Atlanta
• New York DO (Private) Harlem
• New Jersey MD (Private) Florham Park
• Pennsylvania DO (Private) Pittsburg
• MD (Public) Scranton
• Tennessee DO (Private) Harrogade
• Texas MD (Public) El Paso
• Washington DO (Private) Yakima
• Note private signifies for profit in many
  instances

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Conclusions Physican Workforce

• Contrary to predictions of the early 1990s,
  there will be a physician shortage between now
  and the 2030s.
• The self-imposed moratorium on U.S. allopathic
  medical school admissions has left the market
  open for an explosion of
• - Osteopathic medical schools
• - Off-shore (Carribean) for-profit Allopathic
  medical schools
• with further increasing entry of IMGs into the
  U.S. allopathic GME system
• (Unfortunately, GME slots are still essentially
  capped at 1996 levels)

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34
12
43
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Student Debt

• Relative Risk
• No debt 1.000
• 1 - 49,999 1.605
• 50,000 - 99,999 1.607
• 100,000 - 149,999 1.324
• 150,000 or more 1.160

50
0
100
150
gt150
000s
Average debt has increased from 106,000 (1998)
to 142,000 (2004). Debt of gt250,000 by
completion of GME training is now being
encountered.
2004 AAMC Graduation Questionnaire Jeffe DB et
a., Wash.U., 2006
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Student Debt

• Retirement of debt is now a powerful
• motivating factor in choosing a specialty.

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Pathology in the Changing Medical School
Landscape

• Atul Grover, MD, PhD The Changing Physician
  Workforce
• Panel Discussion Changing Paradigms of UME
• Stuart Flynn, MD University of Arizona
  Phoenix
• Ken Sims, MD American University of
  the Carribean
• Mary Ann Sens, MD University of North
  Dakota
• Randy Holmes, PhD The (threatened) Role of Basic
  Science in UME
• Lydia Howell, MD Is the Pathologist as Medical
  Student
• Teacher Endangered in the New Age?