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doi: 10.1097/01.COT.0000293384.11253.c0
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AAMC Calls for 30% Increase in Medical School Enrollment

Because of the growing shortage of physicians, the Association of American Medical Colleges has recommended that enrollment in US medical schools be increased by 30% by 2015, resulting in an additional 5,000 new medical students annually.

“The shortage of US doctors would have a profound effect on all Americans by affecting access to quality health care, especially for the underserved who already encounter substantial barriers to care,” said AAMC President Jordan C. Cohen, MD.

Factors that warrant this increase, the AAMC said, include:

  • ▪ Population increases of 25 million people every decade.
  • ▪ Doubling of the number of people over age 65 between 2000 and 2030.
  • ▪ Americans' rising expectations for, and the increasing availability of, effective health care.
  • ▪ Aging physician workforce; one third of active physicians are over age 55 and likely to retire by 2020.
  • ▪ A new generation of physicians who will probably work less than their predecessors.

If these trends continue, the number of doctors will peak by about 2020 and then drop just as baby boomers begin to reach age 75.

AAMC has several recommendations to alleviate the problem:

  • ▪ Remove the cap on the number of residency positions funded by Medicare. “Increased public support of graduate medical education is essential to guarantee a sufficient supply of doctors,” Dr. Cohen said.
  • ▪ Study the geographic distribution of US physicians and identify strategies to address the paucity in many areas.
  • ▪ Increase the National Health Service Corps awards by at least 1,500 per year to help meet the need for physicians who care for the underserved and help mitigate medical students' indebtedness.
  • ▪ Develop a formal voluntary process for assessing medical schools outside the United States, and establish a mechanism that could oversee the clinical training of US medical students enrolled abroad.
  • ▪ Actively assist medical education and training in other countries.
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FDA Announces New Measures to Protect Against Counterfeit Drugs

The Food and Drug Administration has announced new steps to strengthen existing protections against the growing problem of counterfeit drugs. The measures were recommended in a report by the agency's Counterfeit Drug Task Force and emphasize regulatory actions and use of new technology to safeguard the integrity of the US drug supply.

Among other new measures, FDA will fully implement regulations related to the Prescription Drug Marketing Act of 1987, which requires drug distributors to provide documentation of the chain of custody of drug products (the “pedigree”) throughout the distribution system.

In 2004, the agency had delayed the effective date of regulations regarding pedigrees in order to give the industry time to adopt electronic technology for tracking drugs through the supply chain.

The technology was to be up and running by next year, but it appears that this will not happen, therefore creating confusion about who is required to pass a pedigree and under what conditions. The Drug Marketing Act will be in full force this December.

Other measures designed to prevent counterfeiting include:

  • ▪ Electronic track and trace technology, such as radiofrequency identification, which creates an electronic pedigree for tracking movement of drugs through the supply chain.
  • ▪ Assigning a serial number to every package of marketed drugs.
  • ▪ Uniform identification in preference to state-by-state laws that impose different pedigree requirements.
  • ▪ Consumer education about the benefits of radiofrequency-tagged products.

FDA will provide a guidance, to be published in the Federal Register about how these procedures are to be implemented and which drugs will protected first.

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IOM Reports Say Action Needed to Bolster Emergency Care System

A series of reports from the Institute of Medicine say that the American emergency medical system is overburdened, underfunded, and highly fragmented. As a result, ambulances are turned away from emergency departments once every minute on average, and patients may wait many hours—even days—for a hospital bed.

Moreover, the system is not prepared to handle surges from major disasters such as hurricanes, bombings, or disease outbreaks.

The committee that wrote the report said that Congress should allocate sufficient funds to ensure that emergency departments are equipped to provide prompt and appropriate care. It also recommended reducing crowding, increasing the number of specialists involved in emergency care, and getting all services to work collaboratively to steer patients to the most appropriate facilities.

“Most of us need emergency services only rarely, but we assume that the system will be able to provide rapid, skilled care when we do,” said Committee Chair Gail L. Warden, President Emeritus of Henry Ford Health System in Detroit.

“Unfortunately, the system's capacity is not keeping pace with the increasing demands being placed on it. We need a comprehensive effort to shore up America's emergency medical care resources and fix problems that can threaten the health and lives of people in the midst of a crisis.”

The IOM report discussed three major problems:

  • ▪ Inadequate Funding: Since federal funds for emergency medical care declined abruptly in the early 1980s, first responder services have had to develop haphazardly. Much communication equipment is antiquated and cannot coordinate with hospitals and other area services. In 2003, emergency departments received nearly 114 million patients, a 26% increase over the previous decade, but during that time, there was a net loss of 703 hospitals and 425 ERs.

Two of IOM's recommendations are establishment of a pool of at least $50 million to reimburse hospitals for uncompensated emergency and trauma care, and allocation of $88 million in grants to test ways to improve emergency care.

  • ▪ Overcrowding and Ambulance Diversions: Hospitals do not control the flow of patients; as a result, ambulances are diverted to other ERs—501,000 times in 2003. They also “board” patients in halls or exam rooms until beds become available.

IOM said that federal programs should revise their reimbursement policies to reward hospitals that manage patient flow and penalize those that do not. It also recommended that the Joint Commission on Accreditation of Healthcare Organizations reinstate strong guidelines to reduce crowding, boarding, and diversion.

  • ▪ Regionalization as a Remedy: Patients should be directed not just to the nearest hospital, but to the nearest place that can best meet their needs. This can improve outcomes, mitigate overcrowding, and reduce costs.

Federal agencies should develop criteria to classify all emergency services and ERs in every community on the basis of their capabilities. Such regional collaboration means that not every hospital has to maintain every specialty service, which would help address shortages caused by the dwindling number of specialists.

© 2006 Lippincott Williams & Wilkins, Inc.
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