Securing the Future of Public Health through Advocacy of the Public Health Economy

I recently received an action alert from a prominent medical education organization calling for increased federal funding for physician training programs. Addressing a shortage of up to 124,000 physicians in ten years will ensure access to patient care and readiness for the next public health crisis, claimed the organization. [1] This email prompted several critical reflections. First, their efforts can be understood as public health leadership. Hospital and physician organizations have a longstanding role in public health agenda-setting. Second, the extent of the US physician shortage is widely debated. For over ten years, I served as a medical education researcher and knew that the major accreditor for training programs differed significantly in their assessment - unofficially at least. I recall that the CEO remarked at its international conference several years ago that the urgency of physician shortages was not in the pipeline, but in the geographic distribution of physicians and lack of mid-level providers. In other words, we do not need to increase the rate of physicians entering the workforce as much as address the conditions leading to regional disparities in health care availability due to consolidation, closing of hospitals, and profit-driven health care.[2] “While only 14 percent of Americans—almost 46 million people—live in rural areas, rural communities represent nearly two-thirds of primary care health professional shortage areas (HPSAs) in the country.” [3] I also knew that the accreditor was prevented from political advocacy, unlike many major organizations in this space, because of limitations within its congressional authorization. Many medical education, hospital, and physician organizations encouraged the bipartisan laws in 2020 and 2022 that provide Medicare support for 1,200 residency positions. This new push is seeking to build on their prior legislative success.