Counting physicians in specialties: By what they do or how they train?

Abstract

The number of actively practicing physicians in the United States is not precisely known, nor do we know the total number of physicians required to meet population needs. The possible gap between these two numbers is a controversial issue, especially for primary care physicians. Primary care physicians can be counted in more than one way, either by their "area of practice" (in other words, what they do) or by the specialty in which they train. Regulatory agencies and other health organizations see the area of practice as more relevant to understanding physician supply. In North Carolina, the counts of primary care physicians were historically based on specialty of training. In 2010, the way physicians were counted was changed from definition by specialty of training to definition by area of practice, which resulted in an apparent drop in the number of primary care physicians by more than 16% in a single year. When terms such as "hospitalist," "urgent care," "student health," and "integrative medicine" were added to describe additional practice areas of physicians, most of the loss was accounted for. Researchers, regulators and policy makers need to be aware of the effects of a shift in how physicians are counted and assigned to specialties to understand the extent of pending shortages.