Journal of the American College of Radiology : JACR
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The recent forecast by the Committee on Graduate Medical Education (COGME) of an impending physician workforce shortage has led to a proposal by the Association of American Medical Colleges (AAMC) to expand medical school admissions by 30% over the next 10 years, an ambitious project whose likelihood of success is compromised by numerous factors inherent in the contemporary medical services marketplace.
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After a quarter century of national policy guided by two principal themes-fear of a physician workforce glut and official preference for careers in primary care medicine-the Council on Graduate Medical Education in January 2005 reversed course and announced its projection of a general physician shortage by 2020 and specifically named several specialties, including radiology, in which the shortage would be most severe. In response, the Association of American Medical Colleges initially proposed that medical schools increase enrollment by 15% and subsequently by 30% over the next 10 years. In the first of 3 articles devoted to the physician workforce crisis, the market model is applied to medical services, and questions are raised about the feasibility of the proposed medical school expansion.
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Hospitals routinely enter into contracts with radiology groups for the right to be the exclusive providers of radiologic services at the facilities in exchange for the groups' agreeing to provide and manage all aspects of those services within the hospitals. These exclusive contracts generally result in radiology departments and associated equipment being closed off to physicians who are not part of the contracting groups. ⋯ Part 2 weighs the practical advantages and disadvantages of exclusive contracts for physicians covered and not covered by such contracts and strategies for avoiding them, as well as provisions that can be included in medical staff bylaws to protect physicians from the automatic termination of privileges when a hospital enters into or terminates an exclusive contract. The remainder of the article provides tips on specific provisions of exclusive contracts that should be included or avoided.