A Report Card on the Physician Work Force in the United States

Abstract

I N a 1992 report, 1 the Council on Graduate Medical Education concluded that deficiencies in the physi-cian work force, the medical-education system, and pub-lic policy would hinder efforts to provide high-quality and affordable health care for all people in the United States. A surplus of specialists, shortages of minority physicians and generalists, poor geographic distribution of physicians, and inadequate training of physicians in key practice skills were identified as problems. A series of national goals were recommended that, if attained by the year 2000, would result in a physician work force better suited in composition and skills to respond to health care needs. These goals included limiting the number of federally funded first-year resident positions to 110 percent of the number of graduates of U.S. med-ical schools in 1993; ensuring that at least half of grad-uates who complete training each year begin careers in family practice, general internal medicine, or general pediatrics; doubling the number of African American, Hispanic, and Native American medical students; elim-inating shortages of primary care physicians in specific areas; and improving the skills of practicing physicians. The 1992 report 1,2 and a 1994 report 3 assessed trends in the physician work force and proposed specific leg-islation to help attain these goals. During the national debate on health care reform in 1993 and 1994, the pro-posals were discussed extensively. 4,5 Despite the failure of the reform effort, the financing and delivery of health care in the United States are changing rapidly, and im-balances in the work force remain highly relevant. The movement from fee-for-service coverage to capitation and the growth of integrated systems of managed health care 6,7 profoundly affect requirements for the physi-cian work force, 8-10 medical practice, 11,12 and medical education. 13-16 Some believe regulatory intervention will be needed to bring the physician work force into bal-ance, 17,18 whereas others 19 argue that market forces will align the future supply of physicians with the demand for them. This article constitutes a report card on the physician work force in the United States. T HE S UPPLY OF P HYSICIANS