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Physician
Supply Projections
The baseline projections of physician supply
assume that current patterns of new graduates, specialty
choice, and practice behavior continue.
[7]
The number of active physicians under the age of 75 grew
from approximately 756,000 in 2000 to an estimated 817,500
in 2005, and this number is projected to grow to approximately
951,700 by 2020 if current trends continue (Exhibit 11).
FTE
supply projections provide a more accurate picture of the
adequacy of supply (than do projections of active physicians)
because the FTE projections consider the decrease in average
hours worked as the physician workforce ages and women constitute
a growing proportion of physicians. [8]
The
estimated number of physicians in clinical practice (which
excludes residents and physicians primarily in non-patient
care activities, increases from approximately 635,800 in
2005 to 719,800 by 2020 (Exhibit 12). FTE supply of physicians
engaged primarily in patient care activities (including
residents) grew from approximately 714,000 in 2000 to approximately
764,000 by 2005 (Exhibits 13, 14, and 15). Although total
physicians engaged primarily in patient care grew by approximately
56,000 between 2000 and 2005, the estimated decrease in
average hours worked suggests that during this period the
net increase in total patient care hours was equivalent
to only 50,000 physicians. By 2020, FTE physicians engaged
primarily in patient care is projected to reach 866,000
(a 10 percent increase from current levels).
The projected growth in supply varies substantially
by medical specialty, reflecting differences in the components
of supply (e.g., number of new entrants, age distribution)
for each specialty. If current supply trends continue, the
number of FTE primary care physicians engaged primarily
in patient care is projected to grow approximately 18 percent
between 2005 and 2020, compared to a growth rate of 10 percent
for non-primary care physicians. FTE supply in some surgical
specialties is projected to decline. Reflecting the dynamic
nature of physician supply, an increasing percentage of
first-year residency positions in general surgery have been
filled in recent years; over 95 percent of these positions
were filled in 2005 (AAMC, 2005). Thus, these supply projections
likely overestimate the size of projected shortages and
surpluses within individual specialties because the Nation
can adjust more quickly to inadequacies in the supply of
individual specialties than to inadequacies in the overall
supply of physicians.
The United States Census Bureau’s middle
series population projections suggest that the United States
population will grow by approximately 14 percent between
2005 and 2020, approximately the same rate as FTE physician
supply, resulting in a relatively constant FTE patient care
physician per 100,000 population ratio of approximately
259 (Exhibits 16 and 17).
Exhibit 11. Supply of Total Active
Physicians*: 2000, Projected to 2020
Specialty |
Base
Year |
Projected |
Percent
Change from
2005–2020 |
2000 |
2005 |
2010 |
2015 |
2020 |
Total |
756,050 |
817,440 |
872,900 |
919,060 |
951,700 |
16% |
Primary
Care |
277,720 |
306,130 |
331,560 |
354,000 |
371,410 |
21% |
Gen. & Family Practice |
110,990 |
118,360 |
127,110 |
135,940 |
143,350 |
21% |
General Internal Med. |
112,220 |
128,020 |
139,400 |
148,680 |
155,330 |
21% |
General Pediatrics |
54,520 |
59,750 |
65,050 |
69,390 |
72,730 |
22% |
Other
Med. Specialties |
107,540 |
116,260 |
124,420 |
130,310 |
133,720 |
15% |
Allergy |
4,020 |
3,870 |
3,750 |
3,660 |
3,540 |
-9% |
Cardiology |
21,990 |
23,180 |
24,470 |
25,340 |
25,620 |
11% |
Dermatology |
9,990 |
11,100 |
11,780 |
12,390 |
12,880 |
16% |
Gastroenterology |
11,200 |
11,890 |
12,480 |
12,850 |
12,970 |
9% |
Internal Med. Sub Spec |
36,750 |
40,720 |
43,970 |
46,290 |
47,740 |
17% |
Pediatric Cardiology |
1,630 |
1,890 |
2,110 |
2,300 |
2,460 |
30% |
Pediatrics Sub Spec |
12,600 |
13,910 |
15,870 |
17,430 |
18,590 |
34% |
Pulmonary Diseases |
9,350 |
9,700 |
10,000 |
10,050 |
9,940 |
2% |
Surgical
Specialties |
163,780 |
170,350 |
174,850 |
177,990 |
179,300 |
5% |
General Surg Sub Spec |
6,370 |
7,090 |
7,690 |
8,120 |
8,340 |
18% |
General Surgery |
33,980 |
32,700 |
32,460 |
32,210 |
31,880 |
-3% |
Neurological Surgery |
5,290 |
5,450 |
5,570 |
5,650 |
5,670 |
4% |
Obstetrics & Gynecology |
42,780 |
47,150 |
50,630 |
53,470 |
55,580 |
18% |
Ophthalmology |
18,830 |
19,680 |
19,950 |
20,100 |
20,020 |
2% |
Orthopedic Surgery |
24,560 |
25,750 |
26,320 |
26,640 |
26,630 |
3% |
Otorhinolaryngology |
9,970 |
10,410 |
10,580 |
10,700 |
10,730 |
3% |
Plastic Surgery |
6,440 |
6,660 |
6,620 |
6,520 |
6,370 |
-4% |
Thoracic Surgery |
4,930 |
4,690 |
4,520 |
4,320 |
4,100 |
-13% |
Urology |
10,630 |
10,770 |
10,510 |
10,250 |
9,990 |
-7% |
Other
Specialties |
207,010 |
224,710 |
242,070 |
256,760 |
267,260 |
19% |
Anesthesiology |
39,090 |
43,630 |
47,880 |
51,340 |
53,660 |
23% |
Child Psychiatry |
6,650 |
7,730 |
8,830 |
9,930 |
10,920 |
41% |
Diagnostic Radiology |
23,100 |
26,210 |
28,270 |
29,700 |
30,560 |
17% |
Emergency Medicine |
27,460 |
30,840 |
34,640 |
37,620 |
39,890 |
29% |
Gen. Prevent Medicine |
3,670 |
3,090 |
2,880 |
2,780 |
2,750 |
-11% |
Neurology |
13,870 |
15,740 |
17,310 |
18,540 |
19,360 |
23% |
Nuclear Medicine |
1,530 |
1,610 |
1,670 |
1,710 |
1,740 |
8% |
Occupational Medicine |
3,130 |
3,430 |
3,780 |
4,100 |
4,350 |
27% |
Other Specialties |
6,310 |
6,270 |
6,630 |
7,020 |
7,230 |
15% |
Pathology |
20,200 |
20,970 |
21,580 |
22,040 |
22,280 |
6% |
Physical Med. & Rehab. |
7,200 |
8,410 |
9,630 |
10,700 |
11,580 |
38% |
Psychiatry |
41,550 |
43,360 |
45,210 |
47,050 |
48,310 |
11% |
Radiation Oncology |
4,150 |
4,790 |
5,280 |
5,670 |
5,950 |
24% |
Radiology |
9,110 |
8,640 |
8,510 |
8,550 |
8,710 |
1% |
*Includes total active MDs and DOs. Physicians
age 75 and older are excluded.
Note: Totals might not equal sum of subtotals
due to rounding.
Exhibit 12. FTE Supply of physicians
in clinical practice*: 2000, Projected to 2020
Specialty |
Base
Year |
Projected |
Percent
Change from2005–2020 |
2000 |
2005 |
2010 |
2015 |
2020 |
Total |
597,430 |
635,780 |
669,010 |
699,450 |
719,940 |
13% |
Primary
Care |
214,810 |
228,660 |
244,370 |
259,910 |
271,440 |
19% |
Gen. & Family Practice |
89,710 |
94,380 |
99,850 |
105,460 |
109,980 |
17% |
General Internal Med. |
82,250 |
88,620 |
95,410 |
102,230 |
106,910 |
21% |
General Pediatrics |
42,850 |
45,670 |
49,110 |
52,230 |
54,560 |
19% |
Other
Med. Specialties |
84,460 |
90,130 |
93,040 |
96,370 |
98,540 |
9% |
Allergy |
3,320 |
3,140 |
2,970 |
2,860 |
2,730 |
-13% |
Cardiovascular Disease |
18,690 |
19,540 |
19,940 |
20,370 |
20,420 |
5% |
Dermatology |
8,630 |
9,420 |
9,880 |
10,310 |
10,680 |
13% |
Gastroenterology |
9,660 |
10,220 |
10,430 |
10,630 |
10,650 |
4% |
Internal Med. Sub Spec |
27,450 |
29,350 |
30,240 |
31,620 |
32,650 |
11% |
Pediatric Cardiology |
1,210 |
1,410 |
1,530 |
1,650 |
1,750 |
24% |
Pediatrics Sub Spec |
8,060 |
9,360 |
10,440 |
11,490 |
12,390 |
32% |
Pulmonary Diseases |
7,460 |
7,690 |
7,610 |
7,450 |
7,270 |
-5% |
Surgical
Specialties |
134,470 |
138,990 |
141,750 |
143,140 |
143,090 |
3% |
General Surg Sub Spec |
5,780 |
6,410 |
6,900 |
7,180 |
7,310 |
14% |
General Surgery |
23,610 |
22,570 |
21,970 |
21,510 |
21,040 |
-7% |
Neurological Surgery |
4,220 |
4,380 |
4,490 |
4,520 |
4,490 |
3% |
Obstetrics & Gynecology |
35,990 |
38,790 |
41,280 |
43,240 |
44,630 |
15% |
Ophthalmology |
16,820 |
17,440 |
17,560 |
17,550 |
17,350 |
-1% |
Orthopedic Surgery |
20,170 |
21,210 |
21,740 |
21,870 |
21,710 |
2% |
Otorhinolaryngology |
8,440 |
8,820 |
8,980 |
9,050 |
9,030 |
2% |
Plastic Surgery |
5,760 |
5,890 |
5,820 |
5,690 |
5,510 |
-6% |
Thoracic Surgery |
4,480 |
4,270 |
4,070 |
3,850 |
3,620 |
-15% |
Urology |
9,200 |
9,200 |
8,950 |
8,680 |
8,400 |
-9% |
Other
Specialties |
163,690 |
178,010 |
189,860 |
200,020 |
206,860 |
16% |
Anesthesiology |
33,560 |
37,680 |
41,080 |
43,690 |
45,250 |
20% |
Child Psychiatry |
5,550 |
6,440 |
7,240 |
8,070 |
8,800 |
37% |
Diagnostic Radiology |
18,130 |
20,570 |
22,100 |
23,120 |
23,640 |
15% |
Emergency Medicine |
21,890 |
25,450 |
28,490 |
30,770 |
32,490 |
28% |
Gen. Prevent Medicine |
2,160 |
1,850 |
1,680 |
1,620 |
1,560 |
-16% |
Neurology |
10,810 |
12,040 |
12,870 |
13,660 |
14,160 |
18% |
Nuclear Medicine |
1,230 |
1,280 |
1,300 |
1,320 |
1,330 |
4% |
Occupational Medicine |
2,320 |
2,520 |
2,690 |
2,880 |
3,020 |
20% |
Other Specialties |
3,280 |
3,200 |
3,290 |
3,400 |
3,450 |
8% |
Pathology |
14,240 |
14,730 |
14,880 |
14,970 |
14,940 |
1% |
Physical Med. & Rehab. |
5,790 |
6,830 |
7,770 |
8,610 |
9,250 |
35% |
Psychiatry |
33,120 |
33,630 |
34,410 |
35,510 |
36,230 |
8% |
Radiation Oncology |
3,560 |
4,100 |
4,500 |
4,810 |
5,020 |
23% |
Radiology |
8,090 |
7,690 |
7,560 |
7,600 |
7,730 |
0% |
*Includes MD and DO office-based and hospital
staff physicians. Excludes residents and those in nonpatient
care.
Physicians
age 75 and older are excluded.
Note: Totals might not equal sum of subtotals due to rounding.
Exhibit 13. FTE Supply of physicians
in clinical practice, and residents*: 2000, Projected to
2020
Specialty |
Base
Year |
Projected |
Percent
Change from 2005 to2020 |
2000 |
2005 |
2010 |
2015 |
2020 |
Total
Patient Care |
713,800 |
764,400 |
808,100 |
842,700 |
866,400 |
13% |
Primary
Care |
267,100 |
292,100 |
313,200 |
331,100 |
344,700 |
18% |
General Family Practice |
107,700 |
114,000 |
121,400 |
128,600 |
134,700 |
18% |
General Internal Medicine |
107,500 |
121,900 |
131,400 |
138,800 |
143,900 |
18% |
Pediatrics |
51,900 |
56,200 |
60,400 |
63,700 |
66,100 |
18% |
Non-primary
Care |
446,800 |
472,400 |
494,900 |
511,500 |
521,700 |
10% |
Medical
Specialties |
86,400 |
91,200 |
96,100 |
99,400 |
101,300 |
11% |
Cardiology |
20,600 |
21,300 |
22,200 |
22,800 |
22,900 |
8% |
Other Internal Medicine |
65,900 |
69,800 |
73,900 |
76,600 |
78,500 |
12% |
Surgical
Specialties |
159,400 |
164,600 |
167,800 |
169,600 |
169,800 |
3% |
General Surgery |
39,100 |
31,700 |
31,400 |
31,100 |
30,800 |
-3% |
Obstetrics/Gynecology |
41,500 |
45,300 |
48,000 |
50,100 |
51,600 |
14% |
Ophthalmology |
18,400 |
19,100 |
19,200 |
19,200 |
19,100 |
0% |
Orthopedic Surgery |
24,100 |
25,000 |
25,500 |
25,600 |
25,500 |
2% |
Other Surgery |
16,200 |
22,900 |
23,300 |
23,300 |
23,000 |
0% |
Otolaryngology |
9,800 |
10,100 |
10,300 |
10,400 |
10,300 |
2% |
Urology |
10,400 |
10,400 |
10,100 |
9,900 |
9,600 |
-8% |
Other
Specialties |
200,900 |
216,600 |
230,900 |
242,600 |
250,600 |
16% |
Anesthesiology |
37,800 |
41,800 |
45,400 |
48,300 |
50,000 |
20% |
Emergency Medicine |
26,300 |
29,100 |
32,200 |
34,500 |
36,300 |
25% |
Pathology |
17,200 |
17,700 |
18,000 |
18,100 |
18,200 |
3% |
Psychiatry |
38,300 |
39,700 |
41,000 |
42,300 |
43,100 |
9% |
Radiology |
30,900 |
33,100 |
34,700 |
35,800 |
36,500 |
10% |
Other Specialties |
50,400 |
55,400 |
59,700 |
63,600 |
66,400 |
20% |
*Includes
MDs and DOs. Residents are not FTE-adjusted. Specialties
are grouped to agree with those groupings shown in the projected
requirements tables, Exhibits 30 and 32. Physicians
age 75 and older are excluded.
Note:
Totals might not equal sum of subtotals due to rounding.
Specialties are aggregated to be comparable to the specialty
categories from the Physician Requirements Model (see Exhibit
30).
[D]
[D]
[D]
[D]
[D]
[D]
Total
active, patient care physicians is projected to increase
to 891,000 by 2020, but the number of FTE physicians is
projected to increase to only 866,000 (Exhibit 18). Under
the assumption that physician productivity increases by
1 percent annually (e.g., through improved training, technological
advances, and increased use of other health professionals),
by 2020 the actual physician supply would be equivalent
to approximately 1,057,000 physicians (in comparison to
year 2000 physicians).
The
PSM can also be used to project supply under alternative
United States medical school output scenarios. As shown
in Exhibit 19, if medical schools could instantaneously
increase the number of graduates by 10 to 20 percent, the
impact on physician supply by 2020 would be approximately
30,000 to 60,000 additional physicians.
While
the future national supply of physicians is relatively straightforward
to project in the aggregate, projections by medical specialty
are more difficult to calculate because a large number of
factors influence specialty choice. Furthermore, the number
of medical school graduates has been relatively constant
over the past two decades while the number of physicians
choosing a particular specialty can vary substantially from
year to year.
If specialty
choice trends from the late 1990s and early 2000s continue,
the number of FTE physicians in primary care specialties
will grow approximately 18 percent between 2005 and 2020,
compared to a growth rate of 10 percent for non-primary
care physicians. There appears to have been a swing back
towards specialization in the past few years, reflecting
the dynamic nature of specialty choice.
The
PSM attempts to capture the major trends affecting physician
supply but is a relatively simple representation of the
millions of supply-related decisions physicians and the
institutions make that affect physician training and practice.
Like all projection models, the accuracy of the projections
diminishes with the time horizon such that short-term projections
are likely more accurate than longer-term projections. Similarly,
projections for broader categories of medical specialties
are likely more accurate than projections for narrowly defined
medical specialties. Furthermore, many physician specialties
have overlapping scopes of practice that blur the distinction
between individual related specialties. |