At a meeting last week of the Federal Council on Graduate Medical Education (COGME), the members discussed a working draft of a report on the adequacy of the physician supply through 2020. The draft report concludes that there will be a physician shortage in 2020, assuming the current level of production and practice patterns of physicians, and patterns of service use. The draft was prepared by the Center for Health Workforce Studies (CHWS), SUNY Albany, under contract to COGME. According to the draft report, the demand and the need for physicians in 2020 will significantly exceed the national supply. Several factors underlie the trend affecting the demand and need for physician services, including population growth and aging, increasing health care utilization, and the nation's expected economic growth. The model being used by CHWS assumes that the supply will continue to grow but not as rapidly as the demand and need for services. The relatively slow growth in the supply of physicians reflects the steady level of production over the past 20 years, the aging of the physician workforce, and new physician lifestyle choices. The draft report included several potential recommendations, including a modest increase in the number of U.S. medical school positions, an increase in the number of training positions available in the United States and the removal of the Medicare reimbursement "cap" on residency positions, and an expansion of the scope of practice of nurse practitioners and physician assistants.