Critique of the Final Report of the Graduate Medical Education National Advisory Committee

I. INTRODUCTION: THE GMENAC REPORT In 1976, the federal government took two major steps that were to have a major impact on public attitudes and policies toward the health professions. (1) Congress passed the Health Professions Educational Assistance Act of 1976, formally declaring an end to the notion that there was an overall shortage of physicians in the United States, and emphasizing geographic and primary care shortages instead. (2) Earlier, in April of the same year, the Department of Health, Education and Welfare (DHEW), now the Department of Health and Human Services (DHHS), established the Graduate Medical Education National Advisory Committee (GMENAC) to advise the Secretary of DHEW on a set of issues related to the health professions. The formal charge to GMENAC included five specific questions: ( a ) What number of physicians is required to meet the health care needs of the nation? ( b ) What is the most appropriate specialty distribution of these physicians? ( c ) How can a more favorable geographic distribution of physicians be achieved? ( d ) What are the appropriate ways to finance the graduate medical education of physicians? ( e ) What strategies can achieve the recommendations formulated by the Committee? After 4½ years of meetings, analysis, and developing and applying a complex methodology, GMENAC has now completed its work. Its recently published conclusions and recommendations are the subject of this policy statement. II. GMENAC9s APPROACH GMENAC chose a ten-year span for its analysis, producing separate estimates for supply of and requirements for health professionals in 1990. Decisions on whether there would be a "shortage" or a "surplus" in a given field were based on a comparison of estimated supply with estimated requirements; the Panel9s recommendations were, in turn, based on those decisions.