  |
|
|
Physician
Requirements
Five studies have been undertaken to determine projections for physician
requirements for the next century. Four of these studies are demand-based
methodologies, and one large-scale effort - the Graduate Medical Education
National Advisory Council (GMENAC) Study - utilized a needs-based methodology
to estimate requirements for practicing physicians. The GMENAC model
projected physician need based on the prevalence of illness and estimates
by provider panels of physician services required to manage these illnesses.
Conversely, the demand based models establish their assumptions on the
manner in which medical services are paid (eg, the percentage of capitated
managed care versus fee-for-service) and current patterns of utilization.
COGME places special emphasis on those demand models that assume increasing
domination of the health care system by managed care arrangements. These
systems use fewer patient care physicians per 100,000 population and
a higher proportion of generalists than do the fee-for-service arrangements
that have dominated health care delivery in this nation.
For all five models, requirements for patient care generalist physicians
in year 2000 lie within a range of 60-80 generalists per 100,000 population.
Specialist requirements in the five models varied from 82-138 specialists
per 100,000 population. The differences in the five models lie in the
degree to which historic increases in the demand for specialists are
assumed to continue in the increasingly competitive managed care setting.
Given the widespread consensus that the future health care system
will be dominated by manage care (ie, capitated financing with strong
utilization controls), COGME believes that ranges of patient care generalists
between 60-80 per 100,000 population and specialists between 85-105
per 100,000 population are reasonable estimates of physician utilization
in the early 21st century. COGME believes that market forces will
at least balance increasing demand for specialty services resulting
form new technology. Consequently, increasing demand for specialists
is not anticipated.
If physician staffing patterns were at the midpoint of the requirement
ranges (165 patient care physicians with 70 generalists and 95 specialists
per 100,000 population) the workforce would consist of approximately
42% generalists and 58% specialists. In comparison, in the year 2000,
COGME projects 203 patient care physicians with 63 generalist and 140
specialists per 100,000 population - a specialty mix of 31% generalists
and 69% specialists.
Comparison of
Alternative Supply Scenarios With Requirements
In its Third and Fourth Reports, COGME recommended that the nation
reduce the number of physicians entering GME to the number of United
States allopathic (MD) and osteopathic (DO) medical school graduates
plus 10%, and that at least 50% of these residency graduates enter practice
as generalists. This recommendation and various alternative scenarios
of numbers of first-year residents and alternative specialty mixes were
compared with the aforementioned patient care physician requirement
ranges.
If recent patterns of residency education continue with first-year
residency positions at a level of 140% of U.S. medical graduates and
an output of 30% generalists and 70% specialists, imbalances between
supply and requirements will worsen. Generalist supply will remain in
the lower portion of the requirement range of 60-80 generalists per
100,000 population. At the same time, the patient care specialist supply
will increase to 152 physicians per 100,000 population in 2010, far
above COGME's estimated requirement range of 85-105 specialists per
100,000 population. The number of specialists will be 100,000 above
the upper level of the range in the year 2000 and will grow to 130,000
above the range by the year 2010. At the some time, the supply of generalists
will be 48,000 below the top of the requirement range in the year 2000
and will be approximately 39,000 below the upper end of the range in
2010
[D] [D]
|
|
