That the AMA support the enactment of limits on US residency positions within a comprehensive workforce reform plan. (MSS Sub. Res. 17, A-95, Adopted in lieu of Res. 17, 37, 38, 42; AMA Res. 327, A-95, Adopted)

Recommends that the AMA-MSS adopt the following statements based on the recommendations in CME/CLRPD joint Report A-94, "Physician Workforce Planning Strategies," and instruct its delegate to the AMA-HOD to support these recommendations:

(1) That the AMA-MSS support the concepts embodied in recommendations 1 and 2 of CME/CLRPD Report A-94, "Physician Workforce Planning Strategies."

(2) That the AMA-MSS support an amendment to recommendation 3 of CME/CLRPD Report A-94, "Physician Workforce Planning Strategies," by deletion on page 9, lines 40 and 41, to read as follows: "Attempts to adjust the physician workforce should consist of an appropriate mix of market and other forces; utilizing voluntary, private sector planning; the initiation of appropriate incentives; and addressing the wide range of factors which influence personal career choice. If the former do not succeed, some intervention by the payors will be inevitable.

(3) That the AMA-MSS support the following changes to CME/CLRPD Report A-94, "Physician Workforce Planning Strategies:"

(a) Deletion of recommendation 4.

(b) Substitution of recommendation 5(a) with the following: "The AMA should support legislation establishing a national physician workforce planning process. Participants in this process should oppose statute mandated targets for the size or specialty mix of the physician workforce, or the number or specialty mix of positions in the country's GME system. Physician workforce and GME reform goals should be established and modified as necessary on an ongoing basis only by an appropriately constituted physician workforce planning body.

(c) Insertion on page 10, line 23, to read as follows: "This body should include medical students, residents, and representatives from medical organizations, such as the AMA..." (MSS Report G, A-94, Adopted as Amended)

That the AMA support a positive, long-term approach to the primary care shortage by supporting the further development and dissemination of information in the form of written materials, video, and/or other media, about primary care rotation opportunities as coordinated by Area Health Education Centers (AHECs) and that the AMA encourage medical schools to increase their involvement in the AHEC program. (MSS Sub. Res. 4, A-94, Adopted; AMA Res. 309, I-94, Adopted)

That the AMA-MSS support the concept that any national workforce planning efforts be research-based and take into account regional needs and variations. (MSS Sub. Res. 4, I-93, Adopted)

That the AMA-MSS oppose the proposed new role of the Accreditation Council for Graduate Medical Education to provide residency program quality assessments to governmental work force policy boards for their use in residency needs planning. (MSS Sub. Res. 3, I-93, Adopted)

That the AMA support the concept that the Council on Graduate Medical Education and/or any equivalent national workforce planning body should be solely advisory in nature and be appointed in a manner that ensures bipartisan representation, including adequate physician representation. (MSS Sub. Res. 2, I-93, Adopted; AMA Res. 320, I-93, Referred)

Asked that the AMA strongly oppose primary care quota systems; that the AMA oppose efforts by federal and state governments which would arbitrarily further control specialties for which medical students may qualify; that the AMA study and report back at A-93 on strategies that may be used for capping graduate medical education positions as proposed by the Council on Graduate Medical Education Third Report; that the AMA continue to support and promote the identification of and funding for incentives to increase the number of primary care physicians. (AMA Res. 325, I-92; AMA Sub. Res. 306 Adopted in lieu of Res. 325)

Asked that the AMA-MSS ask the AMA to support the continuation and expansion of the NHSC loan repayment program. (MSS Amended Res. 3, I-89)

Asked the AMA to strongly urge Congress to support the current level of funding of direct and indirect medical education costs in the Medicare program. (AMA Res. 246, A-89; AMA Sub. Res. 181 Adopted in lieu of Res. 246)

Directed the MSS to join the AMA in its strong opposition to the reduction of Medicare Funding of graduate medical education; and that the MSS publicize in an appropriate manner, to all medical students, the potential for the elimination or reduction of Medicare Funding of graduate medical education and the consequential development of uncompensated residency positions. (MSS Sub. Res. 21, A-85)

Asked the AMA to endorse the principle that all third party payors should support both direct and indirect costs of graduate medical education. (AMA Res. 83, I-84; CME Report E, I-84, Adopted)

Adopted the following principles: (1) The US Government should provide preferential support (e.g., financial aid) to US citizens enrolled in US medical schools, as opposed to alien and US FMG's. (2) There should be guidelines to limit the number of FMG's entering the US for the purpose of graduate medical training as well as to practice medicine modified as appropriate in response to assessment of needs. Public policy toward extending the rights of foreign-trained physicians to practice in the US should be sensitive to the impact of the individual's practice on the health care delivery system. (3) Immigration legislation should allow adequate time to complete training. (4) Steps should be taken to aid developing countries in providing incentives for their physicians to return to or remain in their own country. (5) Determination of an individual's qualifications should include assessment of the individual student or medical school graduate as well as the foreign medical school attended. (6) Individuals contemplating a career in medicine should be informed of the requirements necessary to successfully enter the US medical profession as well as residency training programs' preference for graduates of US medical schools. (MSS Position Paper 1, A-83)

(1) Physician workforce planning should be based on physician-to-population ratios, taking into account regional and national demographic characteristics and needs, and any alterations in the structure of the present healthcare delivery system. Such planning should not be based on an arbitrary percent distribution by specialty.

(2) Any analysis of physician supply should be based on numbers of physicians and the proportion of time that they are actively involved in patient care and on the different health delivery systems where they practice rather than on the total physician population.

(3) Attempts to adjust the physician workforce should consist of an appropriate mix of market and other forces; utilizing voluntary, private sector planning; the initiation of appropriate incentives; and addressing the wide range of factors which influence personal career choice.

(4) Planning to restructure the physician workforce should consider the utility of the following strategies, singly and in combination: limiting the number of medical students, limiting the number of entry level residency positions, and retraining of practicing physicians.

(5) In order to maximize physician involvement in workforce planning and to respond to current pending legislation designed to place planning solely in federal hands, the planning process should both redefine existing structures and consider additional bodies for a private initiative in workforce planning. Medical students and residents should be involved in all levels of workforce planning. The physician workforce planning infrastructure could include three basic components:

(a) The AMA should support the creation of a "National Health Workforce Advisory Council," a public/private body, advisory to the Secretary of the Department of Health and Human Services and to Congress, whose charge would be to study and make recommendations on workforce issues in all the health professions. While the Council would make recommendations about physician workforce goals, it would not become involved in the direct implementation of workforce policies designed to achieve those goals (such as the allocation of graduate medical education positions).

(b) A "Graduate Medical Education Commission," a private-sector body composed predominantly of individuals knowledgeable about medical education and physician workforce planning, should be established to address issues related specifically to the nature of the nation's GME system. This body should include representatives from medical organizations, such as the AMA, which have a tradition of dealing with medical education issues on a broad basis. The Commission would provide data to policy makers, act as a forum for the development of planning strategies and methodologies, and work with government policymakers and the medical education community to develop specific policies on the implementation of physician workforce goals.

(c) Graduate medical education consortia should be established to provide a mechanism for the integration of undergraduate and graduate medical education activities on a local, regional, or state basis. The consortia, which should be private, voluntary, self-governing bodies, would be responsible for actual implementation of appropriate changes in the size and specialty mix of GME programs sponsored within the consortium, based on local or regional needs as well as national goals. Each consortium should include at least one medical school and an appropriate mix of non-hospital and hospital-based patient care settings. There should be flexibility in the organization of consortia, which should not be restricted by specific geographic boundaries. The consortia would provide regional data to the "Graduate Medical Education Commission" for use in developing recommendations on national workforce planning and for making decisions regarding allocation of GME positions.