U.S. Facing Doctor Shortage, Not Surplus, Latest Study Finds
A widely anticipated surplus of doctors at the turn of the century, a scenario that envisions a health care delivery system awash in physicians, is not likely to materialize and instead could turn out to be a doctor shortage, a new projection now concludes.
In a study published today, researchers argue that an 8-year-old federal government analysis projecting the enormous surplus is flawed and that the year 2000 could instead be one of long patient waits for appointments and in the physician’s office.
Moreover, an 18-month-old government study group is also preparing to deliver a preliminary report agreeing that an overall doctor shortage may develop, even though a surplus may now exist; that there are already too few family physicians, and there will soon be a clear shortage of specialists in general internal medicine.
The research team, from Tufts University School of Medicine, found that a 1980 U.S. government-financed study predicting the surplus has already spawned an exodus of primary care physicians into such activities as sports medicine clinics, nutrition centers, drug abuse programs and nursing homes.
That factor combined with expanded numbers of physicians taking administrative jobs and the changing nature of health care delivery, in which institutional providers increasingly replace the traditional solo practice office, plays a large role in assuring that, even if there is a small doctor surplus by the year 2000, the actual availability of mainstream patient care could be constrained, the analysis concludes in an essay published today in the New England Journal of Medicine.
Dr. William Schwartz and the other Tufts researchers predict that, allowing for the decline in work hours by women doctors who modify their schedules to accommodate raising families and the transfer to non-patient care duties of as many as 93,000 physicians among other variables, there will be only 585,000 doctors actually practicing medicine by the turn of the century.
That will be 7,000 fewer than demand for services would optimally require, according to the Schwartz team, which found a higher number of physicians will be required to provide basic patient care than the earlier government panel had predicted. Today’s study is a follow-up on research published in January that predicted shortages in certain specialties by the turn of the century.
The new government panel, the Council on Graduate Medical Education, is to meet next month to approve a report to be sent to Congress in July. Dr. Neal Vanselow, of the University of Minnesota and the council chairman, said Wednesday the committee will specifically recommend that the federal government take no additional steps to limit the supply of physicians because the surplus on which the policy is based either may not materialize or might not be harmful even if it did.
Vanselow said the panel, which was formed in 1986 to determine whether the widely heralded doctor surplus was actually going to occur, is finding that although a surplus may be taking shape now, its duration is impossible to predict and primary care medical specialties seem headed toward certain shortage conditions.
There is already a shortage of family practice physicians and there is an “impending shortage” of doctors in general internal medicine, he said. But, he added, weaknesses in data-collection techniques make it virtually impossible to predict physician supply-demand relationships with any accuracy.
Both findings challenge the conclusions of the Graduate Medical Education National Advisory Committee, a panel appointed by the U.S. Department of Health and Human Services in 1980 in response to fears that medical schools were producing too many physicians who in turn would inordinately drive up the costs of health care.
The committee predicted that, by the turn of the century, there would be 145,000 more physicians than necessary to provide adequate patient care--643,000 doctors competing for an amount of work that could be accomplished by 466,000. The committee’s widely publicized conclusions are considered to be partly responsible for a drop in applications to medical schools, the size of first-year enrollments and the total number of medical students nationwide. In addition, its predictions have resulted in various federal money incentives to increase the number of medical students and physicians being phased out or eliminated.
According to the American Medical Assn., applications for medical school in 1986 and 1987 were fewer than at any time in the last decade and first-year enrollment was at its lowest since the late 1970s. The total number of people attending medical education programs was the lowest since 1982.
In addition to these developments, experts say a plethora of other reasons include demands for medical services that may be made by the AIDS epidemic, changes in productivity among physicians as doctors in salaried programs devote fewer hours per week to patient care and the arrival of more complex treatment systems.
The aging of the population, the emergence of better insurance coverage and the possible development of a national health insurance program will also play a role, the experts add.
