A dwindling medical workforce.(GUEST EDITORIAL)

America is facing a major shortage of nurses and doctors, with no real solution in sight. For more than half a century, we have depended on foreign health professionals to satisfy our domestic requirements. U.S. medical and nursing schools have failed to respond to this need. It is difficult to understand our reluctance (or inability) to train our own physician workforce, because the shortfall between supply and demand has been evident for some time.

According to data drawn from the 2004 United States Physician Masterfile, about 200,000, or 25%, of our practicing physicians were trained outside this country. More than 60% of those were trained in low-income countries such as India, the Philippines, and Pakistan (N. Engl. J. Med. 2005;353:1810-8). Another 25,000 were U.S. citizens who received their medical training abroad, many in medical schools in the Caribbean and Mexico.

Not until recently has there been any significant change in the number of students entering medical schools in this country. Between 1971 and 1985, American medical school graduates increased from about 10,000 to 16,000 per year. Since 1985, the number of graduates has been flat.

In the last 20 years, there has been a significant change in the makeup of medical school classes as female graduates have increased and male graduates have decreased in numbers. In 2004, there were just 1,000 fewer female graduates than male graduates. During the same period, there has been a gradual increase in both African American and Hispanic students.

According to a report from the Association of American Medical Colleges, for the first time in almost two decades there was an increase of 2.1% in medical school enrollees to more than 17,000 ...