HEALTH CARE REFORM MAY CREATE SURPLUS OF SPECIALISTS By Lisbeth Pettengil By the year 2000, if health care reform is enacted or managed care plans continue to grow at the current rate, there may be a "surplus" of as many as 150,000 medical specialists practicing in the United States. This was the major finding of a study in the July 20 issue of the _Journal of the American Medical Association_. "It is evident to me that we can no longer avoid the issue of an impending surplus of medical specialists," said Jonathan P. Weiner, author of the study and associate professor of health policy and management at the School of Public Health. "The economic and social costs of doing otherwise are too great." The study also predicted there would not be a shortage of generalist physicians, even though patients in HMOs use proportionately more primary care services than do patients in fee-for-service insurance plans. "Although the predictions of all work force forecasting efforts must be considered as having a considerable margin of error, the results of this study are dramatic," Dr. Weiner said. The study based its predictions on the assumption that by the turn of the century, 40 to 65 percent of all Americans will receive their health care from health maintenance organizations or other types of managed care networks, an increase of about 30 percent from today's figures. It also made the assumption that the uninsured will have health care coverage and that all people would receive services from doctors at the same rate. Beginning with these assumptions, the study used staffing data from 20 large HMOs to project the number of physicians that would be required to meet the needs of Americans in a reformed health care system. After adjusting for known differences between the general population and patients presently served by HMOs, the study indicated that one practicing doctor for every 710 patients would be needed for adequate service. In the next six years, however, the ratio of doctors in the United States to patients is expected to increase significantly. All the additional doctors are expected to be specialists, not generalists. Steven A. Schroeder, president of the Robert Wood Johnson Foundation, responded to the study in the same issue of _JAMA_. "Faced with surpluses of the magnitude projected by Weiner and others, the nation is faced with two choices: It can look to the market to recalibrate the work force, or we can attempt to manage it more directly," Dr. Schroeder wrote. "Knowing that the federal government is the major underwriter of graduate medical education," he added, "it would seem only prudent that the active management of total physician supply--at the very least--should become a national priority." A blue ribbon federal advisory panel requested the study.
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