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Other
Potential Determinants of Demand for Physician Services
One of the challenges in projecting physician
requirements is that changes in technology, the use of non-physician
clinicians (NPCs) and other health workers, public expectations,
and government policies all can alter use patterns and the
way care is delivered. Because of uncertainties regarding
what new developments might occur and their impact on demand
for physician services, the baseline projections assume
constant physician per population ratios over the two decades
of projections. Below, we describe trends that could affect
physician requirements.
- Technological
advances. Technological advances continue to
change the way in which healthcare services are delivered.
Some new technologies create immediate additional demand
for physician services (e.g., advances in fertility technology);
other advances hold the potential to prevent costly medical
conditions (e.g., gene therapy), thus immediately reducing
the demand for selected services. Predicting how such
advances will change the long-run demand for physician
services is difficult. For instance, new techniques in
invasive cardiology might help prevent costly surgeries
and their comorbidities, but the added years of life gained
from such procedures might translate into greater use
of services over an individual’s lifetime. Similarly,
telemedicine has the potential to reduce access barriers
thus increasing demand for physician services.
- Non-Physician
Clinicians. The NPC workforce continues to grow
as does the proportion of healthcare services NPCs provide
(Cooper, Laud, and Dietrich, 1998; Druss et al., 2003).
Although NPCs sometimes compete with physicians, they
also complement physicians by providing services within
the scope of their training with physicians directing
overall care and handling the more complex cases. Increased
use of NPCs allows physicians to become more productive
(e.g., in terms of seeing more patients), which increases
the supply of physician services but also means we need
fewer physicians to provide care to a given population.
- Public
expectations. Public expectations of medicine
are different today than they were 100 years ago, or even
20 years ago. New medicines have improved the ability
to care for chronic conditions, and others have improved
quality of life for many individuals. The Institute of
Medicine (IOM) has highlighted the prevalence of medical
errors, leading to increased scrutiny of quality of care
by the public and by policymakers. The elderly baby boom
population will have experienced different hardships than
their grandparents, which might also affect their expectations
of the healthcare system. Physician specialties involved
in both acute and long-term care of the elderly will be
affected.
- Policy
changes. The changing role of government, which
is closely linked to public expectations, might also exert
a significant impact on demand for physician services
(e.g., through the impact of regulation as well as payment
policies).
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