This Clinician's View is written by Joseph Portoghese, MD, chief of chief academic officer & Designated Institutional Official (DIO) at AdventHealth.
According to the latest projections from the Association of American Medical Colleges (AAMC), the U.S. will face a shortage of up to 86,000 physicians by 2036 with several challenges fueling this deficit:
- The population is projected to grow by 8.4%.
- The 65 and older population is expected to increase by 34.1%, including a 54.7% increase in those 75 and older – individuals who require more health care and health care providers.
- Many physicians will reach retirement age in the next decade. Those 65 or older represent 20% of the current clinical physician workforce, and those age 55-64 comprise another 22%. The AAMC forecasts that more than a third of currently active physicians could retire within the next decade.
- The 2024 Medscape Physician Burnout & Depression Report: “We Have Much Work to Do” revealed that nearly half (49%) of physicians said they felt burned out, posing yet another threat.
Closer to home, Mary Mayhew, President and CEO of the Florida Hospital Association, recently shared that the physician shortage in Florida is projected to reach 18,000 by 2035.
As physician leaders, we hold a tremendous responsibility and opportunity to help ensure continued access to quality health care by properly training tomorrow’s physician workforce today. At AdventHealth, we remain committed to this mission.
Growing Graduate Medical Education (GME)
Graduate medical education (GME) programs, especially those at community health care systems like ours, play a critical role in addressing the physician shortage. In fact, according to the AAMC, of Florida’s nearly 8,616 residents who completed training between 2012 and 2021, 63 percent stayed in the state after completing their residency to practice medicine.
However, the benefits of GME go deeper than that. As the leader of AdventHealth’s GME efforts for almost 20 years, I believe these residency and fellowship programs make our hospitals, our physicians and our communities better in several ways:
- Bring fresh ideas, approaches and energy that help us to continually improve and innovate.
- Foster an academic culture and encourage research that elevates our reputation and enhances patient care.
- Expand our workforce, especially in high-need specialties.
- Provide our current physicians with opportunities to teach and reconnect with their passions.
At AdventHealth, we also believe in the power of collaboration and are actively involved in the Alliance for Independent Medical Centers (AiAMC), where I will be serving as the organization’s President in the coming year. This is a national organization of approximately 90 independent teaching hospitals that are committed to the application of innovative educational solutions to drive better clinical outcomes. We share best practices and believe GME can serve as a strategic asset in attaining continuous improvement in patient care. We work together on national initiatives to help our members thrive in the ever-changing regulatory and accreditation environment.
GME at AdventHealth – Nearly Five Decades of Leadership
The mission of AdventHealth, and of our GME programs, is "to extend the healing ministry of Christ." We do so by preparing and training competent, highly qualified physicians, who will provide exceptional whole-person care with uncommon compassion in communities they will serve both now and in the future.
My personal calling to this work runs deep. I was the first person in my family to attend college and immediately went on to attend medical school. I have never taken my education for granted and have always loved the teaching aspect of medicine, whether with my patients, medical students or fellow physicians.
AdventHealth began its Family Medicine residency in 1974. I joined the medical staff in 1989, and in 1990, I gladly accepted the opportunity to serve on the teaching faculty for the Family Medicine Residency program. Then, in 2006, I helped to establish and lead the General Surgery Residency Program. A couple of years later, I accepted my current leadership position as Chief Academic Officer and Designated Institutional Officer (DIO).
Our GME has been on a path of steady growth the past 20 years. We added an Emergency Medicine Residency in 2007, which is now run in partnership with TeamHealth, and our Internal Medicine Residency launched in 2008. Most recently, we added residencies in Obstetrics and Gynecology as well as Orthopedic Surgery in partnership with Rothman Orthopaedics. I’m proud to share that in all, we now have more than 25 ACGME-accredited programs across Florida in the following specialties:
RESIDENCIES
- Emergency Medicine
- Family Medicine
- Internal Medicine
- General Pediatrics
- General Surgery
- Obstetrics and Gynecology
- Orthopedic Surgery
- Diagnostic Radiology
FELLOWSHIPS
- Cardiovascular Disease
- Colon and Rectal Surgery
- Critical Care Medicine
- Gastroenterology
- Gynecologic Oncology
- Hospice and Palliative Care
- Geriatric Medicine
- Primary Care Sports Medicine
- Osteopathic Manipulation and Musculoskeletal Procedures (ONMM3)
Building the Physician Workforce
GME programs at community health care systems like AdventHealth hold unique advantages for residents and fellows, including exposure to a diversity of patients, conditions, procedures and services. For me, GME is also a giant family, and the greatest reward and honor is when a physician who completes one of our programs goes on to become an AdventHealth medical staff colleague:
- Devina McCray, MD, was one of our first General Surgery Residency graduates and now serves as a breast surgeon with AdventHealth Cancer Institute in Orlando. She recently partnered with another AdventHealth physician to perform Central Florida’s first immediate neurotization after breast reconstruction, a new surgical technique designed to restore breast sensation after nipple-sparing mastectomy.
- General surgeon Jeffrey Chiu, MD, was born at AdventHealth Orlando, completed our General Surgery Residency there, and now works at AdventHealth East Orlando, specializing in minimally invasive laparoscopic and robotic surgery, as well as breast, endocrine and gastrointestinal surgery.
- Coming full circle, several physicians who trained with us now serve as GME faculty, including surgeons George Weise, MD; Michael Gregg, MD; and Jonah White, MD; internal medicine faculty Luis Isea Mercado, MD; and Radiology Program Director Michele Edison, MD, just to name a few.
These are just some of our many GME success stories.
Planning for Future Needs
We know our work is far from done, and AdventHealth must continue to invest in developing the future generation of physicians. It takes one to two years to create and implement a new GME program, and we are currently talking to our stakeholders to define expectations for the next five years. This includes carefully analyzing community and institutional needs along with physician shortages in specialties like radiology and urology.
AdventHealth is also working to expand its relationship with Loma Linda Medical School, a partnership that allows their medical students to complete clinical training at our Florida hospitals. This helps to further strengthen our GME programs by providing a new pipeline of applicants to our various residencies.
We are proud of the more than 1,000 physicians who have completed our GME programs over the past 50 years and look forward to continuing this critical work, growing our physician workforce so that we can fulfill our mission for generations to come.
