Enormous changes are occurring in the organization and financing of the U.S. health care system—rapid changes that are being driven by market forces rather than by government initiatives. Although it is difficult to predict what they system will look like once it begins to stabilize, the changes will affect all components of the health care workforce, and the numbers and types of health care professionals that will be needed in the future—as well as the roles they will fill—will surely be much different than they were in the past.
Despite numerous studies in the past 15 years showing that we might have more doctors than we need, the number of physicians in residency training continues to grow. At the same time, there is evidence that the demand for physician services will decrease as a result of growth of managed care. All of this is evidence that the demand for physician services will decrease as a result of growth of managed care. All of this is taking place at a time when, coincident with the result of failure of comprehensive health care reform, there is no coordinated and widely accepted physician workforce policy in the United States. The present study examines the following three questions: (1) Is there a physician policy in the United States? (2) If there a surplus, what is its likely impact on the cost, quality, and access to health care and on the efficient use of human resources? (3) What realistic steps can be taken to deal with a physician surplus? December
- The Nation's Physician Workforce: Options for Balancing Supply and Requirements
- Copyright
- Preface
- Acknowledgments
- Contents
- Summary
- U.S. PHYSICIAN SUPPLY AND REQUIREMENTS
- RELATIONSHIP OF PHYSICIAN SUPPLY TO KEY ELEMENTS OF THE HEALTH CARE SYSTEM
- STRATEGIES FOR ADDRESSING PHYSICIAN SUPPLY ISSUES
- Producing Physicians from U.S. Medical Schools
- Revamping Graduate Medical Training
- Controlling IMG Numbers through GME
- Replacement Funding for IMG-Dependent Hospitals
- Data Collection and Information Dissemination
- CONCLUDING STATEMENT
- 1 Introduction
- THE PHYSICIAN WORKFORCE
- THE MATCH—OR MISMATCH—BETWEEN SUPPLY AND REQUIREMENTS
- ORIGINS AND ORGANIZATION OF THE STUDY
- Charge to the Committee and Project Activities
- Related Issues
- Principles Underlying Committee Conclusions and Recommendations
- ORGANIZATION OF THIS REPORT
- 2 U.S. Physician Supply and Requirements: Match or Mismatch?
- PHYSICIAN WORKFORCE ISSUES SINCE WORLD WAR II
- General Issues
- Pre-1980s Era
- Current Status
- Physician Workforce Trends
- Overall Trends in Supply
- Trends in Graduate Medical Education
- METHODS OF ESTIMATING PHYSICIAN SUPPLY, PRODUCTIVITY, AND REQUIREMENTS
- Physician Supply
- Physician Productivity
- Physician Requirements
- THE FUTURE REQUIREMENT FOR PHYSICIANS
- Factors That Could Increase Requirements
- Factors That Could Decrease Requirements
- Managed Care
- Use of Nonphysician Personnel
- INTERNATIONAL COMPARISONS
- MATCH OR MISMATCH?
- Conclusions of Physician Workforce Studies
- Evidence from the Marketplace
- Physician Incomes
- Other Evidence
- CONCLUSION
- NOTES
- APPENDIX
- A Brief Note on Managed Care
- 3 Relationship of Physician Supply to Key Elements of the Health Care System
- HEALTH CARE EXPENDITURES
- Competition
- Physician Incomes
- Health Care Costs
- ACCESS TO CARE
- Geographic Distribution
- Specialty Distribution
- Summary Comment About Access to Care
- QUALITY OF CARE
- High Numbers of Physicians Overall
- General Effects
- Volume and Quality
- Provider and Consumer Satisfaction
- Specialist-Generalist Issues
- Education and Training
- Issues Relating to IMGs
- Costs, Quality, and Physician Supply
- Summary Comment
- OTHER ISSUES IN PRODUCTION AND UTILIZATION OF THE PHYSICIAN WORKFORCE
- Human Resources Considerations
- Opportunities for Medical Careers
- U.S. Policy and the World Output of Physicians
- Future of Academic Health Centers
- General Issues
- The Service-Training Link and IMG-Dependent Institutions
- CONCLUSION
- NOTES
- 4 Strategies for Addressing Physician Supply Issues
- DO NOTHING: THE FREE OR UNREGULATED MARKET APPROACH
- INSTITUTE CENTRAL FEDERAL REGULATION
- General Approaches to Planning and Managing Physician Supply
- Committee Views
- A CONSTRAINED MARKET APPROACH
- Antitrust Considerations
- Production of Physicians from U.S. Medical Schools
- Revamp Graduate Medical Training
- Reduce GME Positions Without Changing GME Funding
- Reduce First-Year Residency Positions and Change The Approach to GME Funding
- Disconnect Funding of Service Delivery From Physician Training
- Specific Controls on Immigration
- Central Government Regulation
- Controlling IMG Numbers Through GME
- Replacement Funding for IMG-Dependent Hospitals
- Data Collection and Information Dissemination
- CONCLUDING STATEMENT
- NOTES
- References
- APPENDIX Biographies of Committee Members
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