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April 5, 1995

Freeze the Number of Medicare-Subsidized Graduate Medical Education Positions

Author Affiliations

From the Institute of Medicine, National Academy of Sciences, Washington, DC.

JAMA. 1995;273(13):1057-1058. doi:10.1001/jama.1995.03520370099046

The national debate over the nation's physician workforce continues.1 There is increasing consensus that we are educating too many physicians, and a general agreement exists that this excess is reflected in too many subspecialists.1,2 Some believe that market forces of supply and demand will ultimately resolve the generalist-subspecialist dilemma. Indeed, salaries for generalists are rising, income for subspecialists is falling, and managed care organizations are increasingly requiring subspecialists to serve as primary care providers or laying them off. Medical students seem to be responding to the marketplace by indicating an increasing interest in generalist careers. Within the relatively short period of time between 1992 and 1994, graduating seniors have increased their interest in generalism from 14% to 23% (unpublished data, Association of American Medical Colleges, 1995). Those who favor regulation argue that the market moves too slowly and that the patient care needs of academic health centers continue

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