The global pipeline: too narrow, too wide or just right?

BACKGROUND: Access to a well-trained workforce is one of many factors underscoring the global health divide that separates industrialized and developing nations. This paper describes the distribution and physician output of the world's medical schools, compares regional physician to population ratios, examines population trends and points out potential mismatches between output and anticipated demographic changes. METHOD: This paper has used multiple data sources in published and electronic form from organized medicine, international health institutions and the medical literature. In addition, a stratified, random survey of 130 medical schools was conducted to determine annual numbers of graduates. RESULTS: Tracking the number and distribution of medical schools and their student capacity is a complex task. The number of medical schools and the estimated number of graduates per population vary by region. In areas of predicted substantial population growth, the production of physicians is neither adequate to meet future needs, nor sufficient to overcome low physician-population ratios. Regions with high physician-population ratios and either expected population decline or small population gains over the next 50 years appear to have an over-capacity to train medical students. CONCLUSION: This paper emphasizes the need for new methods of tracking the global pipeline of medical education and of establishing ways of sharing expertise. The growing interdependence of nations, accentuated by globalization of the world's economies, our shared goal of achieving health for all and the migration of physicians across borders highlight the need to understand the global capacity to educate the next generation of physicians.