Appearing in the May/June 1997 issue of Public Health Reports
Researchers at the Health Resources and Services Administration's Bureau of Health Professions estimate the specialty-specific reductions or downsizing of the physician workforce that would be required if the nation is to maintain the physician specialty to population ratios that exist today--a third for specialists and one fifth for primary care physicians. Only family practice, neurosurgery, otolaryngology, and urology did not require downsizing. Seventeen medical and hospital based specialties (including 7 of 10 internal medicine subspecialties) needed downsizing by at least 40%. Less downsizing was needed in the surgical subspecialties and psychiatry. A managed care dominated system would call for greater downsizing inmost of the non-primary care specialties.
The researchers assumed that 1993 physician to population ratios would be maintained. They then estimated, specialty by specialty, the growth in supply (new practicing physicians and the reductions due to death and retirement) that would be needed to keep pace with population growth. These numbers were compared to the numbers of new specialty board certificates. Then using data form several sources and assuming that workforce needs would change in a system increasingly dominated by managed care, the authors estimated further specialty-specific downsizing required for a managed care dominated environment.
To maintain the 1993 199.6 active physician per 100,000 population ratio, 14,644 new physicians would be needed each year. Given that an average of 20,655 physicians were certified each year between 1990 and 1994, at least 6011 fewer new physicians were needed to maintain 1993 levels. To maintain the 132.2 ratio of active non-primary care physicians per 100,000 population, the system needed to produce 9698 non-primary care physicians per year; because an average of 14,527 new non-primary care physicians entered the workforce between 1990 and 1994, downsizing by 4829 or 33% was needed.
To maintain the 66.8 active primary care physicians per 100,000 population ration, 4946 new primary care physicians were needed per year; since primary care averaged 6128new certifications per year, a downsizing of 1182, or 20% was indicated. Only family practice, neurosurgery, otolaryngology, and urology did not require downsizing. Seventeen medical and hospital based specialties, including 7 of 10 internal medicine subspecialties, needed downsizing by at least 40%. Less downsizing in general was needed in the surgical subspecialties and in psychiatry. A managed care dominated system would call for greater downsizing in most of the non-primary care specialties.