0
September 7, 1994, Vol 272, No. 9 >
ARTICLE | September 7, 1994

Seeking a Balanced Physician Workforce for the 21st Century FREE

Richard A. Cooper, MD
[+] Author Affiliations

Reprint requests to Health Policy Institute, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226 (Dr Cooper).


JAMA. 1994;272(9):680-687. doi:10.1001/jama.1994.03520090044017
Text Size: A A A
Published online
Article
References

THE HALLS of academia and the chambers of Congress echo with a call for more primary care physicians. Much of this stems from the need that managed care systems have for more primary care providers.1-4 In addition, many believe that more primary care physicians would improve access to care in rural towns and inner cities.5-7 There also is a perception that we have too many specialists and that the care they provide is too expensive,3,8-14 and there is alarm that the proportion of physicians training in primary care is decreasing.4,7-9,14-20

A consensus has developed that better balance in the proportion of primary care physicians and specialists must be achieved, and this consensus has been translated into a specific proposal: that the percentage of medical graduates entering the primary care disciplines of family medicine, general internal medicine, and general pediatrics be increased from the recent levels of

REFERENCES

1 +
Kronick R, Goodman DC, Wennberg J, Wagner E.  The marketplace in health care reform. N Engl J Med . 1993;;328:148-152.
2 +
Weiner JP.  Forecasting the effects of health reform on US physician workforce requirements: evidence from HMO staffing patterns. JAMA . 1994;; 272:222-230.
3 +
Wennberg JE, Goodman DC, Nease RF, Keller RB.  Finding equilibrium in US physician supply. Health Aff (Millwood) . 1993;;12:90-103.
4 +
Mullan F, Rivo ML, Politzer RM. Doctors, dollars  and determination: making physician workforce policy. Health Aff (Millwood) . 1993;;12( (suppl) ):138-151.
5 +
Center for General Health Services Intramural Research. National Medical Expenditure Survey: Health Status and Access to Care of Rural and Urban Populations . Washington, DC: Agency for Health Care Policy and Research; 1994;. Research findings 18.
6 +
Ginzberg E.  Improving health care for the poor. JAMA . 1994;;271:464-467.
7 +
Council on Graduate Medical Education. Improving Access to Health Care Through Physician Workforce Reform: Directions for the 21st Century . Washington, DC: US Department of Health and Human Services; 1992;.
8 +
Schroeder SA.  The US physician supply: generalism in retreat. Bull N Y Acad Med . 1993;;70:103-117.
9 +
Schroeder S, Sandy LG.  Specialty distribution of US physicians: the invisible driver of health care costs. N Engl J Med . 1993;;328:961-963.
10 +
Greenfield S, Nelson EC, Zubkoff M, et al.  Variation in resource utilization among medical specialties and systems of care. JAMA . 1992;;267:1624-1630.
11 +
Welch WP, Miller ME, Welch G, et al.  Geographic variation in expenditures for physicians' services in the United States. N Engl J Med . 1993;;328:621-627.
12 +
Rosenblatt RA.  Specialists or generalists: on whom should we base the American health care system? JAMA . 1992;;267:1665-1666.
13 +
Grumbach K, Lee PR.  How many physicians can we afford? JAMA . 1991;;265:2369-2372.
14 +
Physician Payment Review Commission. Annual Report to Congress . Washington, DC: Physician Payment Review Commission; 1993;:55-85.
15 +
Association of American Medical Colleges.  Policy on the generalist physician. Acad Med . 1993;;68:1-6.
16 +
Cohen JJ.  Transforming the size and composition of the physician workforce to meet the demands of health care reform. N Engl J Med . 1994;;329:1810-1812.
17 +
Levinsky NG.  Recruiting for primary care. N Engl J Med . 1993;;328:656-660.
18 +
Petersdorf RG.  The doctor is in. Acad Med . 1993;; 68:113-122.
19 +
Colwill JM.  Where have all the primary care applicants gone? N Engl J Med . 1992;;326:387-393.
20 +
Rivo ML, Satcher D.  Improving access to health care through physician workforce reform: directions for the 21st century. JAMA . 1993;;270:1074-1078.
21 +
Rivo ML, Jackson DM, Clare FL.  Comparing physician workforce recommendations. JAMA . 1993;; 270:1083-1084.
22 +
Schroeder SA.  Western European responses to physician oversupply: lessons to the United States. JAMA . 1984;;252:373-384.
23 +
Whitcomb ME. Medical Education/Physician Workforce Issues, England, France and Germany: Report to the Office of Health Professions Analysis and Research . Washington, DC: Bureau of Health Professions; 1994;.
24 +
American Medical Association. Physician Characteristics and Distribution in the US . Chicago, Ill: American Medical Association; 1993;.
25 +
Kindig DA, Cultice JM, Mullan FH.  The elusive generalist physician: can we reach a 50% goal? JAMA . 1993;;270:1069-1073.
26 +
Lundberg GD, Lamm RD.  Solving our primary care crisis by retraining specialists to gain specific primary care competencies. JAMA . 1993;;270:380-381.
27 +
Ginzberg E.  More primary care physicians: an oversimplified answer.  In: Is Primary Care the Answer? Proceedings of the Forum for Medical Affairs . Lake Success, NY: Organization of State Medical Association Presidents; 1993;:77-86.
28 +
Kindig DA.  Counting generalist physicians. JAMA . 1994;;271:1505-1507.
29 +
Meyer CT.  The case for osteopathic physicians.  In: The General Internist: Who, What, Where, When, How and Why! Philadelphia, Pa: American Board of Internal Medicine; 1993;:97-107.
30 +
Rogers JF. Trends in US Health Care 1992 . Chicago, Ill: American Medical Association; 1992;:68-69.
31 +
Rich EC, Wilson M, Midtling J, Showstack J.  Preparing generalist physicians: the organizational and policy context. J Gen Intern Med . 1994;;9( (suppl 1) ):S115-S122.
32 +
Franks P, Nutting PA, Clancy CM.  Health care reform, primary care, and the need for research. JAMA . 1993;;270:1449-1453.
33 +
Starfield B. Primary Care: Concept, Evaluation and Policy . New York, NY: Oxford University Press; 1992;.
34 +
Kimball HR, Young PR.  A statement on the generalist physician from the American Boards of Family Practice and Internal Medicine. JAMA . 1994;; 271:315-316.
35 +
Rivo ML, Saultz JW, Wartman SA, DeWitt TG.  Defining the generalist physician's training. JAMA . 1994;;271:1499-1504.
36 +
Aiken LH, Lewis CE, Craig J, Mendenhall RC, Blendon RJ, Rogers D.  The contribution of specialists to the delivery of primary care. N Engl J Med . 1979;;300:1363-1370.
37 +
Spiegel JS, Rubenstein LV, Scott B, Brook RH.  Who is the primary care physician? N Engl J Med . 1983;;308:1208-1212.
38 +
Schwartz WB, Sloan FA, Mendelson DN.  Why there will be little or no physician surplus between now and the year 2000. N Engl J Med . 1988;;318:892-897.
39 +
Schroeder SA.  The health manpower challenge to internal medicine. Ann Intern Med . 1987;;106:768-770.
40 +
Reuben DB, Zwanziger J, Bradley TB, et al.  How many physicians will be needed to provide medical care for older persons? physician manpower needs for the twenty-first century. J Am Geriatr Soc . 1993;; 41:444-453.
41 +
Williams AP, Schwartz WB, Newhouse JP, Bennett BW.  How many miles to the doctor? N Engl J Med . 1983;;309:958-963.
42 +
Kravitz RL, Greenfield S, Rogers W, et al.  Differences in the mix of patients among medical specialties and systems of care: results from the Medical Outcomes Study. JAMA . 1992;;267:1617-1623.
43 +
Safran DG, Tarlov AR, Rogers WH.  Primary care performance in fee-for-service and prepaid health care systems: results from the Medical Outcomes Study. JAMA . 1994;;271:1579-1586.
44 +
Hendee WR, Urlakis MA, Blackwelder M.  The Health Information Technology Center at the Medical College of Wisconsin. Wis Med J . 1994;;93:159-162.
45 +
Kassirer JP.  What role for nurse practitioners in primary care? N Engl J Med . 1994;;330:204-205.
46 +
Mundinger MO.  Advanced-practice nursing: good medicine for physicians? N Engl J Med . 1994;;330: 211-213.
47 +
DeAngelis CD.  Nurse practitioner redux. JAMA . 1994;;271:868-871.
48 +
Jones PE, Cawley JF.  Physician assistants and health care reform: clinical capabilities, practice activities, and potential roles. JAMA . 1994;;271:1266-1272.
49 +
Cawley JF.  Case for the physician assistants.  In: The General Internist: Who, What, Where, When, How and Why! Philadelphia, Pa: American Board of Internal Medicine; 1993;:117-133.
50 +
Fowkes V, Gamel N, Garcia RD, Wilson SR, Stewart BR. Assessment of Physician Assistant (PA), Nurse Practitioner (NP) and Nurse-Midwife (CNM) Training on Meeting Health-Care Needs of the Underserved . Washington, DC: Bureau of Health Professions, US Dept of Health and Human Services; 1993;.
51 +
Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delblanco TL.  Unconventional medicine in the United States: prevalence, cost and patterns of use. N Engl J Med . 1993;;328:246-252.
52 +
Gates PR.  The office of alternative medicine: investigating the future. Alternative Med J . 1994;;1:12-15.
53 +
Association of American Medical Colleges, Graduate Medical Education. Tracking Census, SAIMS Database . Washington, DC: Association of American Medical Colleges; 1994;.
54 +
National Center for Health Statistics. National Vital Statistics System in Health: United States, 1991 . Washington, DC: US Dept of Health and Human Services; 1992;:19. DHHS publication PHS92-1232.
55 +
US Bureau of Census. Population Projections of the United States by Age, Sex, Race, Hispanic Origin: 1992 to 2050 . Washington, DC: US Government Printing Office; 1992;. Current population report P25-1092.
56 +
Kennedy P. Preparing for the Twenty-first Century . New York, NY: Random House; 1993;:21-46.
57 +
Iglehart JK.  Health policy report: health care reform and graduate medical education. N Engl J Med . 1994;;330:1167-1171.
58 +
Kassebaum DG, Szenas PL.  Specialty preferences of 1993 medical school graduates. Acad Med . 1993;;68:866-869.
59 +
1993 Institutional Goals Ranking Report . Washington, DC: Association of American Medical Colleges; 1993;.
60 +
Kassebaum D.  Factors influencing the specialty choices of 1993 medical school graduates. Acad Med . 1994;;69:164-170.
61 +
Foster EA.  Long-term follow-up of an alternative medical curriculum. Acad Med . 1994;;69:501-506.
62 +
Steinbrook R.  Money and career choice. N Engl J Med . 1994;;330:1311-1312.
63 +
Matriculating Student Survey Results, 1993 . Washington, DC: Association of American Medical Colleges; 1994;.
64 +
Stoddard JJ, Kindig DA, Libby D.  Graduate medical education reform: service provision transition costs. JAMA . 1994;;272:53-58.
65 +
Whitcomb ME. The Impact of National Graduate Medical Education (GME) Reform Goals on the GME Activity of Individual States . Princeton, NJ: Robert Wood Johnson Foundation; April 1994;. Report 23577.
66 +
Reinhardt UE.  Coverage and access in health care reform. N Engl J Med . 1994;;330:1452-1453.
67 +
Petersdorf RG.  Financing medical education: a universal 'Berry plan' for medical students. N Engl J Med . 1993;;328:651-654.
68 +
Johns MME.  Mandatory national health service: an idea whose time has come. JAMA . 1993;;269:3156-3157.
69 +
Scherr L, Benson JA, Walt AJ, Blank LL.  Graduate medical education: a national resource in need of renewal.  In: Taking Charge of Graduate Medical Education: To Meet the Nation's Needs in the 21st Century . New York, NY: Josia Macy Jr Foundation; 1993;:151-179.
70 +
Wall EM, Saultz JW.  Retraining the subspecialist for a primary care career: four possible pathways. Acad Med . 1994;;69:261-266.
71 +
Report of the Graduate Medical National Advisory Committee: Summary Report . Washington, DC: US Dept of Health and Human Services; 1981;. DHHS publication HRA 81-651.
72 +
Tarlov AR.  Shattuck lecture: the increasing supply of physicians, the changing structure of the health services system, and the future practice of medicine. N Engl J Med . 1983;;308:1235-1244.
73 +
Petersdorf RG.  Regulating the supply of internists: whose hand should be on the spigot? Internist (Berl) . 1994;;35:7-9.
74 +
Cooper RA.  Regulation won't solve our workforce problems. Internist (Berl) . 1994;;35:10-13.
75 +
Nolan J.  Why we need government regulation. Internist (Berl) . 1994;;35:14-17.
76 +
Feil EC, Welch HG, Fisher ES.  Why estimates of physician supply and requirements disagree. JAMA . 1993;;269:2659-2663.
77 +
Reinhardt UE.  Health manpower forecasting: the case of physician supply in health services research.  In: Ginzberg E, ed. Key to Health Policy . Cambridge, Mass: Harvard University Press; 1991;.
78 +
Martini CJM.  Medical workforce planning and medical education: attaining consensus. JAMA . 1993;; 270:1101-1104.
79 +
Ginzberg E.  Physician supply in the year 2000. Health Aff (Millwood) . 1989;;8:84-90.
80 +
Rogers DE.  On trust: a basic building block for healing doctor/patient interactions. Pharos . 1994;;57: 2-6.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Kronick R, Goodman DC, Wennberg J, Wagner E.  The marketplace in health care reform. N Engl J Med . 1993;;328:148-152.
2 +
Weiner JP.  Forecasting the effects of health reform on US physician workforce requirements: evidence from HMO staffing patterns. JAMA . 1994;; 272:222-230.
3 +
Wennberg JE, Goodman DC, Nease RF, Keller RB.  Finding equilibrium in US physician supply. Health Aff (Millwood) . 1993;;12:90-103.
4 +
Mullan F, Rivo ML, Politzer RM. Doctors, dollars  and determination: making physician workforce policy. Health Aff (Millwood) . 1993;;12( (suppl) ):138-151.
5 +
Center for General Health Services Intramural Research. National Medical Expenditure Survey: Health Status and Access to Care of Rural and Urban Populations . Washington, DC: Agency for Health Care Policy and Research; 1994;. Research findings 18.
6 +
Ginzberg E.  Improving health care for the poor. JAMA . 1994;;271:464-467.
7 +
Council on Graduate Medical Education. Improving Access to Health Care Through Physician Workforce Reform: Directions for the 21st Century . Washington, DC: US Department of Health and Human Services; 1992;.
8 +
Schroeder SA.  The US physician supply: generalism in retreat. Bull N Y Acad Med . 1993;;70:103-117.
9 +
Schroeder S, Sandy LG.  Specialty distribution of US physicians: the invisible driver of health care costs. N Engl J Med . 1993;;328:961-963.
10 +
Greenfield S, Nelson EC, Zubkoff M, et al.  Variation in resource utilization among medical specialties and systems of care. JAMA . 1992;;267:1624-1630.
11 +
Welch WP, Miller ME, Welch G, et al.  Geographic variation in expenditures for physicians' services in the United States. N Engl J Med . 1993;;328:621-627.
12 +
Rosenblatt RA.  Specialists or generalists: on whom should we base the American health care system? JAMA . 1992;;267:1665-1666.
13 +
Grumbach K, Lee PR.  How many physicians can we afford? JAMA . 1991;;265:2369-2372.
14 +
Physician Payment Review Commission. Annual Report to Congress . Washington, DC: Physician Payment Review Commission; 1993;:55-85.
15 +
Association of American Medical Colleges.  Policy on the generalist physician. Acad Med . 1993;;68:1-6.
16 +
Cohen JJ.  Transforming the size and composition of the physician workforce to meet the demands of health care reform. N Engl J Med . 1994;;329:1810-1812.
17 +
Levinsky NG.  Recruiting for primary care. N Engl J Med . 1993;;328:656-660.
18 +
Petersdorf RG.  The doctor is in. Acad Med . 1993;; 68:113-122.
19 +
Colwill JM.  Where have all the primary care applicants gone? N Engl J Med . 1992;;326:387-393.
20 +
Rivo ML, Satcher D.  Improving access to health care through physician workforce reform: directions for the 21st century. JAMA . 1993;;270:1074-1078.
21 +
Rivo ML, Jackson DM, Clare FL.  Comparing physician workforce recommendations. JAMA . 1993;; 270:1083-1084.
22 +
Schroeder SA.  Western European responses to physician oversupply: lessons to the United States. JAMA . 1984;;252:373-384.
23 +
Whitcomb ME. Medical Education/Physician Workforce Issues, England, France and Germany: Report to the Office of Health Professions Analysis and Research . Washington, DC: Bureau of Health Professions; 1994;.
24 +
American Medical Association. Physician Characteristics and Distribution in the US . Chicago, Ill: American Medical Association; 1993;.
25 +
Kindig DA, Cultice JM, Mullan FH.  The elusive generalist physician: can we reach a 50% goal? JAMA . 1993;;270:1069-1073.
26 +
Lundberg GD, Lamm RD.  Solving our primary care crisis by retraining specialists to gain specific primary care competencies. JAMA . 1993;;270:380-381.
27 +
Ginzberg E.  More primary care physicians: an oversimplified answer.  In: Is Primary Care the Answer? Proceedings of the Forum for Medical Affairs . Lake Success, NY: Organization of State Medical Association Presidents; 1993;:77-86.
28 +
Kindig DA.  Counting generalist physicians. JAMA . 1994;;271:1505-1507.
29 +
Meyer CT.  The case for osteopathic physicians.  In: The General Internist: Who, What, Where, When, How and Why! Philadelphia, Pa: American Board of Internal Medicine; 1993;:97-107.
30 +
Rogers JF. Trends in US Health Care 1992 . Chicago, Ill: American Medical Association; 1992;:68-69.
31 +
Rich EC, Wilson M, Midtling J, Showstack J.  Preparing generalist physicians: the organizational and policy context. J Gen Intern Med . 1994;;9( (suppl 1) ):S115-S122.
32 +
Franks P, Nutting PA, Clancy CM.  Health care reform, primary care, and the need for research. JAMA . 1993;;270:1449-1453.
33 +
Starfield B. Primary Care: Concept, Evaluation and Policy . New York, NY: Oxford University Press; 1992;.
34 +
Kimball HR, Young PR.  A statement on the generalist physician from the American Boards of Family Practice and Internal Medicine. JAMA . 1994;; 271:315-316.
35 +
Rivo ML, Saultz JW, Wartman SA, DeWitt TG.  Defining the generalist physician's training. JAMA . 1994;;271:1499-1504.
36 +
Aiken LH, Lewis CE, Craig J, Mendenhall RC, Blendon RJ, Rogers D.  The contribution of specialists to the delivery of primary care. N Engl J Med . 1979;;300:1363-1370.
37 +
Spiegel JS, Rubenstein LV, Scott B, Brook RH.  Who is the primary care physician? N Engl J Med . 1983;;308:1208-1212.
38 +
Schwartz WB, Sloan FA, Mendelson DN.  Why there will be little or no physician surplus between now and the year 2000. N Engl J Med . 1988;;318:892-897.
39 +
Schroeder SA.  The health manpower challenge to internal medicine. Ann Intern Med . 1987;;106:768-770.
40 +
Reuben DB, Zwanziger J, Bradley TB, et al.  How many physicians will be needed to provide medical care for older persons? physician manpower needs for the twenty-first century. J Am Geriatr Soc . 1993;; 41:444-453.
41 +
Williams AP, Schwartz WB, Newhouse JP, Bennett BW.  How many miles to the doctor? N Engl J Med . 1983;;309:958-963.
42 +
Kravitz RL, Greenfield S, Rogers W, et al.  Differences in the mix of patients among medical specialties and systems of care: results from the Medical Outcomes Study. JAMA . 1992;;267:1617-1623.
43 +
Safran DG, Tarlov AR, Rogers WH.  Primary care performance in fee-for-service and prepaid health care systems: results from the Medical Outcomes Study. JAMA . 1994;;271:1579-1586.
44 +
Hendee WR, Urlakis MA, Blackwelder M.  The Health Information Technology Center at the Medical College of Wisconsin. Wis Med J . 1994;;93:159-162.
45 +
Kassirer JP.  What role for nurse practitioners in primary care? N Engl J Med . 1994;;330:204-205.
46 +
Mundinger MO.  Advanced-practice nursing: good medicine for physicians? N Engl J Med . 1994;;330: 211-213.
47 +
DeAngelis CD.  Nurse practitioner redux. JAMA . 1994;;271:868-871.
48 +
Jones PE, Cawley JF.  Physician assistants and health care reform: clinical capabilities, practice activities, and potential roles. JAMA . 1994;;271:1266-1272.
49 +
Cawley JF.  Case for the physician assistants.  In: The General Internist: Who, What, Where, When, How and Why! Philadelphia, Pa: American Board of Internal Medicine; 1993;:117-133.
50 +
Fowkes V, Gamel N, Garcia RD, Wilson SR, Stewart BR. Assessment of Physician Assistant (PA), Nurse Practitioner (NP) and Nurse-Midwife (CNM) Training on Meeting Health-Care Needs of the Underserved . Washington, DC: Bureau of Health Professions, US Dept of Health and Human Services; 1993;.
51 +
Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delblanco TL.  Unconventional medicine in the United States: prevalence, cost and patterns of use. N Engl J Med . 1993;;328:246-252.
52 +
Gates PR.  The office of alternative medicine: investigating the future. Alternative Med J . 1994;;1:12-15.
53 +
Association of American Medical Colleges, Graduate Medical Education. Tracking Census, SAIMS Database . Washington, DC: Association of American Medical Colleges; 1994;.
54 +
National Center for Health Statistics. National Vital Statistics System in Health: United States, 1991 . Washington, DC: US Dept of Health and Human Services; 1992;:19. DHHS publication PHS92-1232.
55 +
US Bureau of Census. Population Projections of the United States by Age, Sex, Race, Hispanic Origin: 1992 to 2050 . Washington, DC: US Government Printing Office; 1992;. Current population report P25-1092.
56 +
Kennedy P. Preparing for the Twenty-first Century . New York, NY: Random House; 1993;:21-46.
57 +
Iglehart JK.  Health policy report: health care reform and graduate medical education. N Engl J Med . 1994;;330:1167-1171.
58 +
Kassebaum DG, Szenas PL.  Specialty preferences of 1993 medical school graduates. Acad Med . 1993;;68:866-869.
59 +
1993 Institutional Goals Ranking Report . Washington, DC: Association of American Medical Colleges; 1993;.
60 +
Kassebaum D.  Factors influencing the specialty choices of 1993 medical school graduates. Acad Med . 1994;;69:164-170.
61 +
Foster EA.  Long-term follow-up of an alternative medical curriculum. Acad Med . 1994;;69:501-506.
62 +
Steinbrook R.  Money and career choice. N Engl J Med . 1994;;330:1311-1312.
63 +
Matriculating Student Survey Results, 1993 . Washington, DC: Association of American Medical Colleges; 1994;.
64 +
Stoddard JJ, Kindig DA, Libby D.  Graduate medical education reform: service provision transition costs. JAMA . 1994;;272:53-58.
65 +
Whitcomb ME. The Impact of National Graduate Medical Education (GME) Reform Goals on the GME Activity of Individual States . Princeton, NJ: Robert Wood Johnson Foundation; April 1994;. Report 23577.
66 +
Reinhardt UE.  Coverage and access in health care reform. N Engl J Med . 1994;;330:1452-1453.
67 +
Petersdorf RG.  Financing medical education: a universal 'Berry plan' for medical students. N Engl J Med . 1993;;328:651-654.
68 +
Johns MME.  Mandatory national health service: an idea whose time has come. JAMA . 1993;;269:3156-3157.
69 +
Scherr L, Benson JA, Walt AJ, Blank LL.  Graduate medical education: a national resource in need of renewal.  In: Taking Charge of Graduate Medical Education: To Meet the Nation's Needs in the 21st Century . New York, NY: Josia Macy Jr Foundation; 1993;:151-179.
70 +
Wall EM, Saultz JW.  Retraining the subspecialist for a primary care career: four possible pathways. Acad Med . 1994;;69:261-266.
71 +
Report of the Graduate Medical National Advisory Committee: Summary Report . Washington, DC: US Dept of Health and Human Services; 1981;. DHHS publication HRA 81-651.
72 +
Tarlov AR.  Shattuck lecture: the increasing supply of physicians, the changing structure of the health services system, and the future practice of medicine. N Engl J Med . 1983;;308:1235-1244.
73 +
Petersdorf RG.  Regulating the supply of internists: whose hand should be on the spigot? Internist (Berl) . 1994;;35:7-9.
74 +
Cooper RA.  Regulation won't solve our workforce problems. Internist (Berl) . 1994;;35:10-13.
75 +
Nolan J.  Why we need government regulation. Internist (Berl) . 1994;;35:14-17.
76 +
Feil EC, Welch HG, Fisher ES.  Why estimates of physician supply and requirements disagree. JAMA . 1993;;269:2659-2663.
77 +
Reinhardt UE.  Health manpower forecasting: the case of physician supply in health services research.  In: Ginzberg E, ed. Key to Health Policy . Cambridge, Mass: Harvard University Press; 1991;.
78 +
Martini CJM.  Medical workforce planning and medical education: attaining consensus. JAMA . 1993;; 270:1101-1104.
79 +
Ginzberg E.  Physician supply in the year 2000. Health Aff (Millwood) . 1989;;8:84-90.
80 +
Rogers DE.  On trust: a basic building block for healing doctor/patient interactions. Pharos . 1994;;57: 2-6.

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