Johns Hopkins Gazette: July 25, 1994

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
     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
     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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