Universities push ceilings on medical school enrollments

As medical school enrollment across the country has increased, universities are still limited in the number of students they can accept due to lack of funding and facility capabilities to teach future physicians and other health professionals.

A projections report by the Association of American Medical Colleges last June on the complexities of physician supply and demand from 2019 to 2034 found that a primary care physician shortage of 17,800 to 48,000 is projected by 2034. Non-primary care specialty physicians are also projected at a shortage of 21,000 to 77,100 by 2034.

Over the past 10 years, a large number of new schools have opened to meet this demand nationally, said Dr. Latha Chandran, executive dean and founding chair of the Department of Medical Education at the University of Miami Miller School and vice chair of the National Board of Medical Examiners.

Between 2002 and 2020, the number of medical students increased by 35% in the nation, she said, when medical colleges suggested that the projected physician shortage would affect healthcare practices and they pushed to increase class sizes and open new schools.

Nationally, the number of applicants to medical schools has been increasing. The academic year 2012 to 2013 saw 45,266 applicants, the following year 48,014, and the one after 49,480. By 2021, American medical schools had 53,030 student candidates, and by 2022, the number reached 62,443, according to the AAMC. Nonetheless, the number of matriculations has stayed relatively the same from about 19,000 to 22,000, with 22,666 medical students matriculated in the 2021-2022 academic year.

The number of graduates at the Miami Miller School of Medicine has slowly increased as well by single digits. In the 2016-2017 academic year, the school had 196 graduates, the class of 2018 had 201. In 2020, the school had 179 graduates of medicine, and by 2021, the graduate number increased to 205. The University of Florida had 150 medical student graduates and Florida International University’s Herbert Wertheim College of Medicine had 113.

“For a long period of time, we didn’t have any additional schools [teaching medicine],” said Dr. Chandran. “But since the AAMC started reporting on shortages we increased the number of medical graduates by about 30%.”

Enrollment in medical schools has grown 31% since 2002, according to the AAMC, and 29 new accredited medical schools have opened since 2002. “Almost all existing medical schools increased in the past years as well,” she added.

But medical school is just one part of equation to become a full physician, Dr. Chandran said. Residency training and then fellowship training, when physicians train on specialty practices, is the other part. “It used to be that for every 100 medical students we had 120 residency spots,” she explained; “and 20 [spots] used to be filled by students who graduated from outside the country, or students who went to Caribbean schools or international medical schools.”

As the number of students undergoing medical training has increased, residency spots have increased as well, but not to the same size, she said. “Congress has been working to increase the number of GME slots — graduate medical education positions — but that has not been so successful.”

The $2.3 trillion Consolidated Appropriations Act of 2021, which became law Dec. 27, 2020, provided funding for 1,000 GME slots for the first time since 1996. The legislation would provide for 200 new positions annually in states where hospitals get no more than 25 residency positions, the American Medical Association (AMA) reported. Other requirements included that at least 10% of those slots be placed in rural areas, that residents be trained over their Medicare GME cap, that those spots be placed in states with new medical schools or branch campuses open since 1999, and that the positions serve areas designated as health professional shortage areas.

“Some hospitals are starting to put their own money and develop GME positions,” said Dr. Chandran. “Because of the financial situation, I don’t think there is going to be a change, unless we repurpose the way we train our students.”

One way to do that, she said, could be under an MD, MPH program. The Miller School of Medicine started a four-year program that is focused on population health, instead of on the individual. The program is the largest in the nation, Dr. Chandran said, and the students focus on public health research. “We graduate every year about 50 students, and we’ve been doing that for about 10 years now.”

Incentivizing more medical students to go into primary care is another example to mitigate the upcoming shortage. “Primary care practice is perhaps the least paid, compared to somebody going into surgical care or specialty care,” she said. “Students come out with significant student loans.”

The Miller School also wants to create more primary care tracks, Dr. Chandran added. “I’ve just had conversations that have gone well for our students to go work at ChenMed – a Medicare-managed company that deals with Medicare Advantages,” she said, adding that in Miami-Dade County, 70% of the Medicare population is in Medicare Advantage, “ChenMed is one of the largest companies in Florida that take care of Medicare Advantage patients. We would be sending our students and the residents to train on how to really take care of patients in the community rather than episodic care.”

In a National Academies of Science, Engineering and Medicine July 2020 report on the staffing considerations for crisis standards of care for the Covid-19 pandemic, it recommended an implementation plan to rebuild a strong foundation for the American health care system.

The implementation plan’s five objectives were for primary care stakeholders to: “pay for primary care teams to care for people, not doctors to deliver services; ensure that high-quality primary care is available to everyone in every community; train primary care teams where people live and work; design information technology that serves the patient, family and interprofessional care team; and ensure that high-quality primary care is implemented in the United States.”

“The National Academies’ recommendation has changed the way primary care [facilities] reimbursed in the US,” Dr. Chandran said, “focusing on the primary care team rather than the single individual, as they’re responsible for the community with input from the community for what its needs are.”