Recent studies indicate that the number of first-year residency positions must increase to meet the United States' projected need for physicians, but these studies rarely consider whether it will be possible to increase the country's graduate medical education system to meet the need. State-level studies suggest that most existing programs have already reached their approved capacity, and nonteaching hospitals are unlikely to create new programs because of the financial impact and their lack of faculty and staff who would meet accreditation standards as program directors and institutional officials. A perfect storm is therefore brewing: The effects of the Patient Protection and Affordable Care Act of 2010, the obesity epidemic, the rise in chronic disease, and the aging and continuing growth of the population will combine to create a much greater demand for medical services at the same time as the relative size of the physician workforce will begin to decline. Given the urgency of the situation, the author calls for medical professionals (with significant representation from the academic medicine community) to enter into meaningful partnerships with state and federal officials to develop strategies for addressing this challenge. They must work together to increase the number of entry-level positions to the level needed to produce the doctors required to meet the growing demand for medical care. Otherwise, the perfect storm will soon disrupt the U.S. health care system.
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