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Background
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.
ACKNOWLEDGEMENTS
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.
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