Salsberg E, Wing P, Dionne M, Zielinski T, Nolan J; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1997; 14: 206.
Center for Health Workforce Studies, School of Public Health, University at Albany, SUNY, Rensselaer, NY 12144, USA.
RESEARCH OBJECTIVE: To project the supply and demand for physicians by specialty in a sub-state region to assist a graduate medical education consortium to determine the appropriate numbers and mix of residents to train. STUDY DESIGN: A wide range of data and indicators were used to develop specialty-specific profiles and to assess and project the supply and demand in sixteen specialities. The study included and "Exit Survey" of all residents completing training in the region as a measure of market demand and program outcomes. The study also assessed the flow of physicians into the region by age cohort and the GME retention rate by specialty based on the AMA Masterfile. A 1994 survey of all practicing physicians in the state (95% response rate) added extensive information on the practice patterns of practicing physicians in the region. Current and projected supply was compated to GMENAC, HMO and other regions of the state. Finally, the recommendations for changes in residency training positions based on the specialty profiles were reviewed with residency directors and chief residents for their assessment of the demand in their specialty. PRINCIPAL FINDINGS: The study developed specific recommendations for sixteen specialities. In some cases, the various indicators of demand and the measures of surplus or shortage were consistent. However, for a number of specialities, the indicators and GMENAC and HMO ratios were inconsistent. The "Exit Survey" proved to be a very valuable tool as a reflection of the real world market. For example, fourteen out of fourteen Family Practice residents reported no difficulty findings a satisfactory practice opportunity; but five of five Pathology residents reported difficulty. Although the supply was below GMENAC and other regions for many specialities, the demand in many specialties appeared to be limited. CONCLUSIONS: Using a variety of data sources and indicators, it is possible to develop a meaningful profile of physician supply and demand in a region. Using multiple indicators and guidelines is far preferable to a single standard of guideline. Given local variations and practice patterns, use of national guidelines for physician to population ratios is inappropriate for a specific region. Surveys of residents completing training provide a useful snapshot of current demand. Discussions with residents indicated the sensitivity of residents to projected opportunities in their specialty. RELEVANCE TO MANAGEMENT AND POLICY: There have been numerous calls to reform GME to train a physician workforce consistent with need; yet there have been only limited efforts to quantify that need by specialty and to use this information for GME decision making. Furthermore, policy makers need to recognize that national goals and needs for physicians may not be consistent with regional or program needs. Far more data and data analysis are needed to better understand factors that impact supply and demand as well as the regional flow of physicians. Finally, improved data collection and methods of projecting supply and demand by specialty by region, and the dissemination of this information to medical students and residents, may prove to be the most effective and politically acceptable approach to encouraging a workforce consistent with need.
Publication Types:
Keywords:
- Data Collection
- Demography
- Education, Medical
- Family Practice
- Health Maintenance Organizations
- Health Services Needs and Demand
- Internship and Residency
- Physicians
- Specialties, Medical
- Students, Medical
- economics
- methods
- supply & distribution
- hsrmtgs
Other ID:
UI: 102233707
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