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July 20, 1994, Vol 272, No. 3 >
ARTICLE | July 20, 1994

Forecasting the Effects of Health Reform on US Physician Workforce Requirement: Title and subTitle BreakEvidence From HMO Staffing Patterns FREE

Jonathan P. Weiner, DrPH
[+] Author Affiliations

An earlier version of this article was commissioned by the Bureau of Health Professions, of the US Department of Health and Human Services, on behalf of the Council on Graduate Medical Education (HRSA PO 03-339-P). This article reflects the opinions of the author and not necessarily the funding agency. The Council on Graduate Medical Education and the Bureau of Health Professions do not necessarily endorse the findings of this article.

Reprint requests to The Johns Hopkins School of Public Health, 624 N Broadway, Room 605, Baltimore, MD 21205 (Dr Weiner).


JAMA. 1994;272(3):222-230. doi:10.1001/jama.1994.03520030064030
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References

This article provides an estimate of the effects of health reform on the US physician workforce requirement. Its basic methodology is to extrapolate current patterns of staffing within managed care plans to the reshaped health care system of the year 2000. In this analysis it is assumed that 40% to 65% of Americans will be receiving care from integrated managed care networks in the near future, and that all citizens will be covered by some type of health insurance. On the basis of these assumptions, this article forecasts that in the year 2000, (1) there will be an overall surplus of about 165000 patient care physicians; (2) the requirement and supply of primary care physicians will be in relative balance; and (3) the supply of specialists will outstrip the requirement by more than 60%. In summation, it appears that national health reform—based largely on an expansion of managed care networks—will have significant impact on the US physician workforce. Concerns have been raised by others that health system reform's shift toward more primary and preventive care will be stymied by workforce availability. This study underscores this concern to some degree. However, the evidence presented herein suggests that the issue is not so much a primary care provider shortage as a specialty care surplus.

(JAMA. 1994;272:222-230)

REFERENCES

1 +
Weiner JP, de Lissovoy G.  Razing a tower of Babel: a taxonomy for managed care and health insurance plans. J Health Polit Policy Law . Winter 1993;;18( (1) ):75-103.
2 +
Hoy E, Curtis R, Rice T.  Change and growth in managed care. Health Aff (Millwood) . 1991;;10:18-36.
3 +
The White House Domestic Policy Council. Health Security: The President's Report to the American People . Washington, DC: US Government Printing Office; 1993;.
4 +
Tarlov R.  HMO growth and physicians: the third compartment. Health Aff (Millwood) . 1986;;5:23-35.
5 +
Steinwachs D, Weiner JP, Shapiro S, et al.  A comparison of the requirements for primary care physicians in HMOs with projections made by the Graduate Medical Education National Advisory Committee. N Engl J Med . 1986;;314:217-222.
6 +
Weiner JP.  The demand for physician services in a changing health care system: a synthesis. Med Care Rev . 1993;;50:411-449.
7 +
Wennberg J, Goodman D, Nease R, Kelso R.  Finding equilibrium in US physician supply. Health Aff (Millwood) . 1993;;12:89-103.
8 +
Mullan F, Rivo ML, Politzer RM.  Doctors, dollars and determination: making physician work-force policy. Health Aff (Millwood) . 1993;; 12( (suppl) ):138-151.
9 +
Straub W. Requirements for Primary Care Professionals Under Managed Competition . Jackson Hole, Wyo: The Jackson Hole Group; 1993;.
10 +
Rivo ML, Satcher D.  Improving access to health care through physician workforce reform: directions for the 21st century. JAMA . 1993;;270:1074-1078.
11 +
Council on Graduate Medical Education. The First Report of the Council . Washington, DC: US Dept of Health and Human Services, Public Health Service, Bureau of Health Professions; 1988;.
12 +
Council on Graduate Medical Education. The Third Report of the Council . Washington, DC: US Dept of Health and Human Services, Public Health Service, Bureau of Health Professions; 1992;.
13 +
Survey of HMOs' Staffing . Washington, DC: Group Health Association of America; 1993;.
14 +
Mulhausen R, McGee J.  Physician need: an alternative projection from a study of large, prepaid group practices. JAMA . 1989;;261:1930-1934.
15 +
Hooker R.  The role of physician assistants and nurse practitioners in a managed care organization.  In: Clawson DK, Osterweis M, eds. The Role of Physician Assistants and Nurse Practitioners in Primary Care . Washington, DC: Association of Academic Health Centers; 1993;:chap 5.
16 +
Physician Characteristics and Distribution in the U.S. Chicago, Ill: American Medical Association; 1993;.
17 +
Osteopathic Physician Distribution . Chicago, Ill: American Osteopathic Association; 1993;.
18 +
Cawley JF.  Physician assistants in the health workforce.  In: Clawson DK, Osterweis M, eds. The Role of Physician Assistants and Nurse Practitioners in Primary Care . Washington, DC: Association of Academic Health Centers; 1993;:chap 3.
19 +
Bureau of Health Professions. Eighth Report to the President and Congress on the Status of Health Personnel in the US . Washington, DC: Dept of Health and Human Services; 1992;. DHHS publication HRS-POD-92-1.
20 +
Weiner JP, Steinwachs DM, Williamson JW.  Nurse practitioner and physician assistant practices in three HMOs: implications for future US health manpower needs. Am J Public Health . 1986;; 76:507-511.
21 +
Kronick R, Goodman DC, Wennberg J, Wagner E.  The marketplace in health care reform: the demographic limitations of managed competition. N Engl J Med . 1993;;328:148-152.
22 +
Patterns of HMO Enrollment . Washington, DC: Group Health Association of America; 1993;.
23 +
HMO Industry Profile—1992 Edition . Washington, DC: Group Health Association of America, Research and Analysis Dept; 1993;.
24 +
National 1990 Population Estimates . Washington, DC: US Bureau of the Census; 1992;.
25 +
Socioeconomic Characteristics of Medical Practice 1992 . Chicago, Ill: American Medical Association; 1993;.
26 +
Franks P, Clancy C, Gold M, Nutting P.  Health insurance and subjective health status: data from the 1987 National Medical Expenditure Survey. Am J Public Health . 1993;;83:1295-1299.
27 +
Scitovsky A, Benham I, McCall N.  Out-of-plan use under two prepaid plans. Med Care . 1981;;19: 1165-1193.
28 +
Weiner JP.  HMOs and managed care: implications for rural physician manpower planning. J Rural Health . 1991;;7:373-387.
29 +
Gamliel S, Politzer R. The Supply and Requirements for Physicians in a Managed Care Environment: BHPr Working Paper . Rockville, Md: US Dept of Health and Human Services; 1993;.
30 +
Kindig DA, Cultice JM, Mullan F.  The elusive generalist physician: can we reach a 50% goal? JAMA . 1993;;270:1069-1073.
31 +
Feil FC, Welch HG, Fisher ES.  Why estimates of physician supply and requirements disagree. JAMA . 1993;;269:2659-2663.
32 +
Summary Report of the Graduate Medical Education National Advisory Committee to the Secretary, Department of Health and Human Services, September 30, 1980 . Washington, DC: US Dept of Health and Human Services; 1981;. DHHS publication HRA-81-651.

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1 +
Weiner JP, de Lissovoy G.  Razing a tower of Babel: a taxonomy for managed care and health insurance plans. J Health Polit Policy Law . Winter 1993;;18( (1) ):75-103.
2 +
Hoy E, Curtis R, Rice T.  Change and growth in managed care. Health Aff (Millwood) . 1991;;10:18-36.
3 +
The White House Domestic Policy Council. Health Security: The President's Report to the American People . Washington, DC: US Government Printing Office; 1993;.
4 +
Tarlov R.  HMO growth and physicians: the third compartment. Health Aff (Millwood) . 1986;;5:23-35.
5 +
Steinwachs D, Weiner JP, Shapiro S, et al.  A comparison of the requirements for primary care physicians in HMOs with projections made by the Graduate Medical Education National Advisory Committee. N Engl J Med . 1986;;314:217-222.
6 +
Weiner JP.  The demand for physician services in a changing health care system: a synthesis. Med Care Rev . 1993;;50:411-449.
7 +
Wennberg J, Goodman D, Nease R, Kelso R.  Finding equilibrium in US physician supply. Health Aff (Millwood) . 1993;;12:89-103.
8 +
Mullan F, Rivo ML, Politzer RM.  Doctors, dollars and determination: making physician work-force policy. Health Aff (Millwood) . 1993;; 12( (suppl) ):138-151.
9 +
Straub W. Requirements for Primary Care Professionals Under Managed Competition . Jackson Hole, Wyo: The Jackson Hole Group; 1993;.
10 +
Rivo ML, Satcher D.  Improving access to health care through physician workforce reform: directions for the 21st century. JAMA . 1993;;270:1074-1078.
11 +
Council on Graduate Medical Education. The First Report of the Council . Washington, DC: US Dept of Health and Human Services, Public Health Service, Bureau of Health Professions; 1988;.
12 +
Council on Graduate Medical Education. The Third Report of the Council . Washington, DC: US Dept of Health and Human Services, Public Health Service, Bureau of Health Professions; 1992;.
13 +
Survey of HMOs' Staffing . Washington, DC: Group Health Association of America; 1993;.
14 +
Mulhausen R, McGee J.  Physician need: an alternative projection from a study of large, prepaid group practices. JAMA . 1989;;261:1930-1934.
15 +
Hooker R.  The role of physician assistants and nurse practitioners in a managed care organization.  In: Clawson DK, Osterweis M, eds. The Role of Physician Assistants and Nurse Practitioners in Primary Care . Washington, DC: Association of Academic Health Centers; 1993;:chap 5.
16 +
Physician Characteristics and Distribution in the U.S. Chicago, Ill: American Medical Association; 1993;.
17 +
Osteopathic Physician Distribution . Chicago, Ill: American Osteopathic Association; 1993;.
18 +
Cawley JF.  Physician assistants in the health workforce.  In: Clawson DK, Osterweis M, eds. The Role of Physician Assistants and Nurse Practitioners in Primary Care . Washington, DC: Association of Academic Health Centers; 1993;:chap 3.
19 +
Bureau of Health Professions. Eighth Report to the President and Congress on the Status of Health Personnel in the US . Washington, DC: Dept of Health and Human Services; 1992;. DHHS publication HRS-POD-92-1.
20 +
Weiner JP, Steinwachs DM, Williamson JW.  Nurse practitioner and physician assistant practices in three HMOs: implications for future US health manpower needs. Am J Public Health . 1986;; 76:507-511.
21 +
Kronick R, Goodman DC, Wennberg J, Wagner E.  The marketplace in health care reform: the demographic limitations of managed competition. N Engl J Med . 1993;;328:148-152.
22 +
Patterns of HMO Enrollment . Washington, DC: Group Health Association of America; 1993;.
23 +
HMO Industry Profile—1992 Edition . Washington, DC: Group Health Association of America, Research and Analysis Dept; 1993;.
24 +
National 1990 Population Estimates . Washington, DC: US Bureau of the Census; 1992;.
25 +
Socioeconomic Characteristics of Medical Practice 1992 . Chicago, Ill: American Medical Association; 1993;.
26 +
Franks P, Clancy C, Gold M, Nutting P.  Health insurance and subjective health status: data from the 1987 National Medical Expenditure Survey. Am J Public Health . 1993;;83:1295-1299.
27 +
Scitovsky A, Benham I, McCall N.  Out-of-plan use under two prepaid plans. Med Care . 1981;;19: 1165-1193.
28 +
Weiner JP.  HMOs and managed care: implications for rural physician manpower planning. J Rural Health . 1991;;7:373-387.
29 +
Gamliel S, Politzer R. The Supply and Requirements for Physicians in a Managed Care Environment: BHPr Working Paper . Rockville, Md: US Dept of Health and Human Services; 1993;.
30 +
Kindig DA, Cultice JM, Mullan F.  The elusive generalist physician: can we reach a 50% goal? JAMA . 1993;;270:1069-1073.
31 +
Feil FC, Welch HG, Fisher ES.  Why estimates of physician supply and requirements disagree. JAMA . 1993;;269:2659-2663.
32 +
Summary Report of the Graduate Medical Education National Advisory Committee to the Secretary, Department of Health and Human Services, September 30, 1980 . Washington, DC: US Dept of Health and Human Services; 1981;. DHHS publication HRA-81-651.

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