The Shortage of Physicians and the Future Role of Nurses

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Abstract
After the Journal of Medical Education was renamed Academic Medicine in the mid-1980s, the journal began to publish articles (both essays and research reports) focusing on a much wider range of topics than before. Although health policy was identified as one of those topics, very few policy-oriented articles have appeared in the journal over the years, primarily because the members of the health policy community have not viewed Academic Medicine as one of the journals to which they should submit their work. Given that, I was delighted when Tim Garson, MD, vice president and dean of the School of Medicine at the University of Virginia, offered to help pull together a collection of articles addressing some of the important contemporary health policy issues facing the country. I was also pleased when Tim agreed to serve as the guest editor for these articles, which appear in this issue of the journal. We hope these articles will offer the leadership of academic medicine useful information and ideas about some of the major health policy issues facing the country. Each of the authors was asked to provide not only an analysis of a particular policy issue, but also, importantly, to give some recommendations for how the academic medicine community might contribute to the development of a solution for that issue. I hope the journal’s readers will pay special attention to those recommendations, in particular, those that urge the medical education community to do a better job educating students and residents about the important health policy issues confronting this country’s leaders. I don’t see how we can expect the next generation of physicians to become effective participants in shaping policy solutions that will serve the public if medical educators don’t do a better job exposing students and residents to the critical issues involved. I hope this collection of articles will be a valuable resource as they strive to do so. One of the policy issues currently receiving a great deal of attention within the academic medicine community is whether the future size of the physician workforce will be adequate to meet the needs of the public for medical care services. The article by Salsberg and Grover provides an excellent overview of the topic and sets forth a number of specific issues that the academic medicine community must confront if the needs of the public are to be met. The authors focus attention on what I believe is a particularly critical question: How much of the future demand for medical services will be met by physicians? If the projections of physician shortages are even close to being accurate, more and more of the services now being provided by physicians will have to be provided by nonphysicians. This presents a major challenge that the profession and policy-makers alike will have to confront to bring about this change in roles, one that I explore in the rest of this editorial: How will the roles of advanced practice nurses (APNs) and other health professionals be defined in the future? In this regard, it is worth noting that the nursing profession is currently reconceptualizing how it views APNs’ roles and is redefining the educational requirements to become an APN. Since I suspect that few of the journal’s readers are familiar with this movement within the nursing profession, a few introductory comments are in order. APNs fall into one of four major categories: nurse anesthetist, nurse midwife, nurse practitioner, and clinical nurse specialist.

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