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Physician Supply and Demand: Projections to 2020


Printer-friendly Physician Supply & Demand Report
Physician Supply Model
Current Physician Workforce
New Entrants and Choice of Medical Specialty
Separations from the Physician Workforce
Trends in Physician Productivity
Physician Supply Projections
Physician Requirements Model
Growth and Aging of the Population
Medical Insurance Trends
Economic Factors
Other Potential Determinants of Demand for Physicians
Physician Requirements Projections
Assessing the Adequacy of Current and Future Supply




The United States continues to debate the adequacy of the current and future supply of physicians. While the general consensus is that overall physician supply per capita will remain relatively stable over the next 15 years, there is less agreement on future demand for physician services. This paper presents projections of physician supply and requirements for 18 physician specialties using the Physician Supply Model (PSM) and the Physician Requirements Model (PRM) developed by the Health Resources and Services Administration (HRSA). In this paper, we describe the data, assumptions and methods used to project the future supply of and requirements for physician services; we present projections from these models under alternative scenarios; and we discuss the implications of these projections for the future adequacy of physician supply.

Accurate projections of physician supply and requirements help preserve a physician supply that is balanced with demand and help the Nation achieve its goal of ensuring access to high-quality, cost-effective healthcare. The length of time needed to train physicians, as well as the time needed to change the Nation’s training infrastructure, suggests that we must know at least a decade in advance of major shifts in physician supply or requirements. The U.S. Government Accountability Office noted in their February 2006 report "Health Professions Education Programs – Action Still Needed to Measure Impact," that regular reassessment of future health workforce supply and demand is key to setting policies as the Nation’s health care needs change.

Past projections of impending physician shortages and surpluses have influenced policies and programs that, in turn, helped determine the number and specialty composition of physicians being trained. During the 1950s and 1960s, projections of a growing physician shortage helped motivate an expansion of the Nation’s medical schools, an increase in government funding for medical education, and the creation of policies and programs that encouraged immigration of foreign-trained physicians. Efforts to increase the physician supply proved so successful that, by the late 1970s, many predicted a growing oversupply of physicians (GMENAC, 1981).

Rising healthcare costs paved the way for managed care and its promises to improve the efficiency of the healthcare system. Enrollment in health maintenance organizations (HMOs) during the 1980s and 1990s prompted reexamination of physician supply adequacy. The greater reliance of HMOs on the use of generalists and the prediction of decreased use of specialist services under managed care led to projections that the United States would have a large surplus of specialists (e.g., COGME, 1992, 1994; Weiner, 1994; IOM, 1996). However, the perceived limitations of the more restrictive forms of managed care prompted a public backlash against many of the forces predicted to decrease healthcare use. Also, some researchers have argued that physician projections that relied heavily on HMO staffing patterns underestimated physician requirements by failing to adequately control for out-of-plan care (Hart et al., 1997) and systematic differences in the health status of the population enrolled in HMOs and the population receiving care under a traditional fee-for-service arrangement.

Cooper et al. (2002) contributed to another round of discussions regarding the adequacy of the future supply of physicians projecting a significant shortage of physicians—particularly specialists—over the foreseeable future. Other researchers have expressed concerns with the assumptions and conclusions used by Cooper et al. (Barer, 2002; Grumbach, 2002; Reinhardt, 2002; Weiner, 2002), but a growing consensus is that over the next 15 years, requirements for physician services will grow faster than supply—especially for specialist services and specialties that predominately serve the elderly. COGME joined the debate using preliminary projections from BHPr’s PSM and PRM, adjusted for COGME’s assumptions regarding the effects of key determinants of supply and requirements, projecting a modest shortfall of physicians by 2020. These projections helped influence the Association of American Medical Colleges (AAMC) decision to encourage growth in the Nation’s medical school training capacity by approximately 15 percent (or 3,000 physicians per year). The primary contributions of our study are (1) projections of overall physician supply and requirements to inform the debate on the Nation’s medical school capacity, and (2) specialty-specific projections of physician supply and requirements under alternative scenarios.


This publication was prepared for the Health Resources and Services Administration by the Lewin Group under Contract Number HRSA-230-BHPr-27(2). Principal researchers were Tim Dall and Atul Grover of the Lewin Group; Charles Roehrig, Mary Bannister, Sara Eisenstein and Caroline Fulper of the Altarum Institute; and James M. Cultice of HRSA.