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September 1, 1993

Improving Access to Health Care Through Physician Workforce Reform: Directions for the 21st Century

Author Affiliations

From the Division of Medicine, Bureau of Health Professions, Health Resources and Service Administration, Rockville, Md (Dr Rivo); and the Meharry Medical College, Nashville, Tenn (Dr Satcher).

JAMA. 1993;270(9):1074-1078. doi:10.1001/jama.1993.03510090058011

THE COUNCIL on Graduate Medical Education (COGME) was authorized by Congress in 1986 to provide an ongoing assessment of physician supply trends and to recommend appropriate federal and private sector efforts to address identified needs. In its first report to the Health and Human Services Secretary and Congress in 1988, the COGME expressed concerns that physician specialty and geographic maldistribution were growing despite an increasing aggregate supply of physicians. Then, concerns about the physician workforce, health care access, and rising costs had not yet been prominently thrust into the national spotlight.

The social context of the council's Third Report, released in October 1992, is vastly different. The health care system is acknowledged to be in a crisis and health care reform is actively being considered. Health care expenditures exceeded $650 billion in 1990 and are projected to reach $1 trillion in 1995. Thirty-five million Americans remain medically uninsured and millions