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September 4, 1996, Vol 276, No. 9 >
ARTICLE | September 4, 1996

Gastroenterology Workforce Modeling FREE

Gregg S. Meyer, MD, MSc; Itzhak Jacoby, PhD; Henry Krakauer, MD, PhD; Don W. Powell, MD; Jeanette Aurand; Peggy McCardle, PhD, MPH
[+] Author Affiliations

The opinions presented here are the authors' alone and should be construed neither as official nor representing the views of the US Department of the Air Force, US Department of Defense, Uniformed Services University of the Health Sciences, US Department of Health and Human Services, National Institutes of Health, or US Public Health Service.

Reprints: ltzhak Jacoby, PhD, Department of preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4999.


JAMA. 1996;276(9):689-694. doi:10.1001/jama.1996.03540090035008
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References

Objective.  —To examine the current supply and distribution of gastroenterologists and project future supply under various scenarios to provide a paradigm for workforce reform.

Design.  —An analysis of current practices and distribution of gastroenterologists and a demographic model, using the 1992 gastroenterology workforce as a baseline.

Main Outcome Measure.  —Comparison of current supply, distribution, and practice profiles with past data and future projections, using analyses of data from the 1993 Area Resource File, 1992 Medicare Part B file, age- and sex-specific death and retirement rates from the Bureau of Health Professions, managed care staffing patterns, the National Survey of Internal Medicine Manpower, and the Bureau of the Census.

Results.  —Rapid growth in the number of US gastroenterologists has resulted in a gastroenterologist-to-population ratio double that used on average by health maintenance organizations. In addition, the work profile of gastroenterologists is shared significantly by primary care physicians and other specialists, with the exception of a few specific and uncommon procedures.

Conclusions.  —Empirical evidence suggests that, even in the absence of detailed models to describe the desired supply/need balance for gastroenterology, the US health care system and clinicians may benefit from a reduction in gastroenterology training programs. The Gastroenterology Leadership Council endorsed a goal of 25% to 50% reduction in trainee numbers over 5 years, and recent National Resident Matching Program data indicate that a voluntary downsizing process is in full force. This study illustrates a paradigm for workforce planning that could be useful for other medical specialties.

REFERENCES

1 +
Farthing MJG, Williams R, Swan CHJ, et al.  Nature and standards of gastrointestinal and liver services in the United Kingdom . Gut . 1993;;34:1728-1739.
2 +
The Pew Health Professions Commission. Critical Challenges: Revitalizing the Health Professions for the Twenty-first Century . San Francisco: University of California, San Francisco, Center for Health Professions; 1995;.
3 +
Institute of Medicine. The Nation's Physician Workforce: Options for Balancing Supply Requirements . Washington, DC: National Academy Press; 1996;.
4 +
Weiner JP.  Internal medicine at the crossroads: training subspecialists for the next century . Ann Intern Med . 1996;;124:681-682.
5 +
Langdon LO, Toskes PP, Kimball HR.  Future roles and training of internal medicine subspecialists . Ann Intern Med . 1996;;124:686-691.
6 +
Rivo ML, Kindig DA.  A report card on the physician work force in the United States . N Engl J Med . 1996;;334:892-896.
7 +
Mullan F.  Graduate medical education and water in the soup . N Engl J Med . 1996;;334:916-917.
8 +
Stambler HV.  The area resource file: a brief look . Public Health Rep . 1988;;103:184-188.
9 +
National Center for Health Statistics. Vital and Health Statistics: Health Service Areas for the United States . Hyattsville, Md: National Center for Health Statistics; 1991;. US Dept of Health and Human Services publication PHS 92-1386.
10 +
Wennberg JE, Goodman DC, Nease RF, Keller RB.  Finding equilibrium in the US physician supply . Health Aff (Millwood) . 1993;;12:89-103.
11 +
Rosenblatt RA, Lishner EM.  Surplus or shortage? unraveling the physician supply conuridrum . West J Med . 1991;;154:43-50.
12 +
Feil EC, Welch HG, Fisher ES.  Why estimates of physician supply and requirements disagree . JAMA . 1993;;269:2659-2663.
13 +
American Gastroenterological Association.  List of available training programs . Gastroenterology . 1993;;105:611-641.
14 +
Lyttle CS, Levey GS.  The National Study of Internal Medicine Manpower, XX: the changing demographics of internal medicine training programs . Ann Intern Med . 1994;;121:435-442.
15 +
Middle Series Estimates. Current Population Reports, Series P-25 No. 1018. Washington, DC: US Bureau of the Census; 1991.
16 +
SAS Statistical Software. Cary, NC: SAS Institute Inc; 1994.
17 +
MapInfo. Troy, NY: MapInfo Corp; 1994.
18 +
SMLTree Version 2.6. Boston, Mass: Pratt Medical Group, New England Medical Center; 1994.
19 +
Summary Report of the Graduate Medical Education National Advisory Committee. Washington, DC: US Dept of Health and Human Services;1980. US Dept of Health and Human Services publication HRA 81-651.
20 +
Modlin IM, Sabesin SM, Snape WJ, Rubin W.  Manpower in gastroenterology in the United States: a position paper of the Training and Education Committee of the AGA . Gastroenterology . 1989;;96:956-957.
21 +
Rand Corp Inc.A Rand Corporation Research Monograph on the Validity of the AMA Physician Master Flle Specialty Designation . Santa Monica, Calif: Rand Corp Inc; 1978;.
22 +
Jacoby I, Meyer GS. Physician Requirements Estimation . Rockville, Md: US Bureau of Health Professions, Health Resources and Services Administration; US Dept of Health and Human Services Monograph; March 1995;.
23 +
McGill DB.  Manpower in gastroenterology . Gastroenterology . 1976;;72:1345-1347.
24 +
McGill DW, Benson JA.  Manpower in gastroenterology . Gastroenterology . 1981;;80:861-863.
25 +
Stillman AE.  Modern times . N Engl J Med . 1995;;333:1086-1087.
26 +
Anderson RJ.  Subspecialization in internal medicine: a historical review, an analysis, and proposals for change . Am J Med . 1995;;99:74-81.
27 +
Kindig DA, Libby D.  How will graduate medical education reform affect specialties and geographic areas? JAMA . 1994;;272:37-42.

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1 +
Farthing MJG, Williams R, Swan CHJ, et al.  Nature and standards of gastrointestinal and liver services in the United Kingdom . Gut . 1993;;34:1728-1739.
2 +
The Pew Health Professions Commission. Critical Challenges: Revitalizing the Health Professions for the Twenty-first Century . San Francisco: University of California, San Francisco, Center for Health Professions; 1995;.
3 +
Institute of Medicine. The Nation's Physician Workforce: Options for Balancing Supply Requirements . Washington, DC: National Academy Press; 1996;.
4 +
Weiner JP.  Internal medicine at the crossroads: training subspecialists for the next century . Ann Intern Med . 1996;;124:681-682.
5 +
Langdon LO, Toskes PP, Kimball HR.  Future roles and training of internal medicine subspecialists . Ann Intern Med . 1996;;124:686-691.
6 +
Rivo ML, Kindig DA.  A report card on the physician work force in the United States . N Engl J Med . 1996;;334:892-896.
7 +
Mullan F.  Graduate medical education and water in the soup . N Engl J Med . 1996;;334:916-917.
8 +
Stambler HV.  The area resource file: a brief look . Public Health Rep . 1988;;103:184-188.
9 +
National Center for Health Statistics. Vital and Health Statistics: Health Service Areas for the United States . Hyattsville, Md: National Center for Health Statistics; 1991;. US Dept of Health and Human Services publication PHS 92-1386.
10 +
Wennberg JE, Goodman DC, Nease RF, Keller RB.  Finding equilibrium in the US physician supply . Health Aff (Millwood) . 1993;;12:89-103.
11 +
Rosenblatt RA, Lishner EM.  Surplus or shortage? unraveling the physician supply conuridrum . West J Med . 1991;;154:43-50.
12 +
Feil EC, Welch HG, Fisher ES.  Why estimates of physician supply and requirements disagree . JAMA . 1993;;269:2659-2663.
13 +
American Gastroenterological Association.  List of available training programs . Gastroenterology . 1993;;105:611-641.
14 +
Lyttle CS, Levey GS.  The National Study of Internal Medicine Manpower, XX: the changing demographics of internal medicine training programs . Ann Intern Med . 1994;;121:435-442.
15 +
Middle Series Estimates. Current Population Reports, Series P-25 No. 1018. Washington, DC: US Bureau of the Census; 1991.
16 +
SAS Statistical Software. Cary, NC: SAS Institute Inc; 1994.
17 +
MapInfo. Troy, NY: MapInfo Corp; 1994.
18 +
SMLTree Version 2.6. Boston, Mass: Pratt Medical Group, New England Medical Center; 1994.
19 +
Summary Report of the Graduate Medical Education National Advisory Committee. Washington, DC: US Dept of Health and Human Services;1980. US Dept of Health and Human Services publication HRA 81-651.
20 +
Modlin IM, Sabesin SM, Snape WJ, Rubin W.  Manpower in gastroenterology in the United States: a position paper of the Training and Education Committee of the AGA . Gastroenterology . 1989;;96:956-957.
21 +
Rand Corp Inc.A Rand Corporation Research Monograph on the Validity of the AMA Physician Master Flle Specialty Designation . Santa Monica, Calif: Rand Corp Inc; 1978;.
22 +
Jacoby I, Meyer GS. Physician Requirements Estimation . Rockville, Md: US Bureau of Health Professions, Health Resources and Services Administration; US Dept of Health and Human Services Monograph; March 1995;.
23 +
McGill DB.  Manpower in gastroenterology . Gastroenterology . 1976;;72:1345-1347.
24 +
McGill DW, Benson JA.  Manpower in gastroenterology . Gastroenterology . 1981;;80:861-863.
25 +
Stillman AE.  Modern times . N Engl J Med . 1995;;333:1086-1087.
26 +
Anderson RJ.  Subspecialization in internal medicine: a historical review, an analysis, and proposals for change . Am J Med . 1995;;99:74-81.
27 +
Kindig DA, Libby D.  How will graduate medical education reform affect specialties and geographic areas? JAMA . 1994;;272:37-42.

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