Physician groups, government agencies and many U.S.
medical schools are concerned with a potential physician
shortage and are calling for an increase in the number of
physicians trained each year.
However, new research from the Johns Hopkins
Bloomberg School of Public
Health found that the current U.S. physician supply is
large enough to meet the needs of patients. Jonathan
Weiner, the study's author and a professor in the
Department
of Health Policy and Management, compared the current
supply of U.S. physicians with the staffing at several
large medical group practices that treat health maintenance
organizations' patients. He found that an increase in the
number of physicians might not be necessary. His study is
featured in the Feb. 4 online issue of the journal
Health Affairs.
"Over the last few years, a general consensus has
developed among medical training institutions that there
are not enough specialist physicians in the educational
pipeline. The question of how many physicians a community
needs has become quite controversial lately, and there has
been precious little evidence to support this debate. By
analyzing the number and types of doctors that serve the
members of these HMOs, considerable light has been shed on
this topic," Weiner said.
Prepaid group practices, or PGPs, are well-organized
multispecialty medical groups that are reimbursed by
capitation to serve the enrollees of HMOs. They were among
the first to establish coordinated approaches to care
delivery and to use nurse practitioners and physician
assistants. Many of the characteristics of PGPs have been
widely copied by other health care plans, even though the
PGP model itself is still relatively new.
The study included not-for-profit PGPs from six units
of Kaiser Permanente, which is based in California, as well
as the Group Health Cooperative of Puget Sound in
Washington and HealthPartners in Minnesota. In total, 8
million consumers at 350 clinic sites and 33 prepaid group
practice- staffed hospitals were studied between 2001 and
2002.
The study found that the HMOs had about one physician
for every 650 patients, compared with the current U.S.
practicing physician supply of one per 400. Also, the HMOs
tend to make greater use of primary care physicians rather
than specialists. However, the study did identify a trend
at the HMOs suggesting that specialist services increased
at a faster rate than generalist care over the last two
decades.
According to the study, almost one-half of the PGP
physicians were female, compared to only 22 percent of the
current U.S. physician workforce. Weiner noted that today's
PGP gender ratio likely foreshadows the future situation,
given that women now comprise about 50 percent of medical
students. In addition, he said workforce planners should
study the trend for women doctors to work fewer hours per
week than their male counterparts.
"PGP medical groups are able to provide care to a
patient population with considerably fewer physicians than
are currently available in the U.S. All told, the
physician-to-population ratios at the three PGPs studied
were about 25 percent lower for primary care physicians and
32 percent lower for specialists. This evidence does not
lend support to the premise that the current national
supply of doctors is inadequate," Weiner said.
He continued, "U.S. policymakers should deliberate
carefully before concluding that expansion of medical
training programs is warranted, especially given the huge
taxpayer subsidy associated with supporting the training of
each new medical professional. The taxpayer price tag is
probably in the range of $750,000 per physician, and we
want to make sure we use those precious health care
resources wisely."
The study was supported in part by a grant from the
Kaiser Foundation Health Plan.