Medicine as a Career

Until about 1980, the increasing need for additional manpower in the health professions, and particularly medical manpower, was shown in governmental studies of both urban and rural areas. Thus medical educators strongly urged that efforts be made to increase the number of physicians and other health science personnel. As a result, increased financial support, especially from the federal government, resulted in expanding first-year enrollment by both enlarging existing medical school class size and by establishing new colleges of medicine. Thus, for example, the number of first-year students increased from about 8,000 in 1960–1961 to more than 11,000 in 1970–1971 and then to about 16,500 first-year places in the early 1980s. All of the six two-year basic science schools were converted to four-year MD-granting institutions. Also, in the 1980s nine new schools became operational, thereby ultimately providing about 750 to 1,000 additional places.

The increase in the number of medical schools and their class size has resulted in a significant narrowing of the gap between physician supply and demand. The number of active physicians increased roughly 12% from 285,000 to 318,000 in the 1965 to 1970 period as against a population growth of only 5%. A similar rate of increase also occurred between 1970 and 1980 as well as in the following decade. The total number of active physicians is approximately 750,000 in the year 2000. This results in a physician-to-population ratio of about 300 per 100,000 in 2000, which is much higher than the 1988 ratio of 223 per 100,000. As a matter of fact, since 1960 the number of physicians has grown four times faster than the population. Thus, on a numerical basis, the gap between physician supply and demand apparently will be closed. A major study of future physician manpower needs, known as the GEMENAC report, which projected an oversupply of physicians, has given rise (not surprisingly) to anxiety among some premedical and medical students, as well as to residents, regarding the need for their services in the twenty-first century.

There are a number of factors to consider when evaluating the conclusion of this report. First, as with all projections based on statistical analysis, they need not be self-fulfilling. Second, a major and unknown impact on the validity of the report's conclusions is the very significant (and long overdue) increase in the enrollment of women in medical schools; women now constitute more than 35% of the student population and their number may rise to 45% or more. An unknown, but perhaps significant, number of these women may initially opt for a specialty of their primary interest but later, to meet personal and/or family needs, gravitate to fields that demand less time. This may leave a void in the supply of physicians specializing in internal medicine, surgery, and other time-intensive fields. Third, the number of American graduates of foreign medical schools may diminish, in view of the drastic change in the “atmosphere” with regard to this option. Fourth, with the size of the applicant pool subject to cyclical fluctuation, there could at some point possibly be a sharp decline (as took place in the mid-1980s). There would then be a tendency for some schools to reduce the size of their entering class, and thus the total number of medical school graduates may, under these conditions, diminish. All the while the population will undoubtedly continue to grow, increasing the demand for medical services (already being fueled by public health education programs).

The aforementioned considerations may have contributed to the significant downward revision in the size of the projected physician surplus that was made by the Department of Health and Human Services over that originally contained in the 1980 GEMENAC report. The overall question of whether there will be a physician surplus, and how big the surplus will be, cannot be resolved with any degree of certainty. The situation is more complex than simply the ratio of the number of physicians to the total population. There is an important issue of an unequal distribution of physicians with rural and inner city areas remaining underserved even when the overall number of physicians has significantly increased. In addition, there is an increasing pressure todeemphasize specialization and strongly encourage the expansion of the number of primary care or family practice physicians. In view of these considerations, the increased number of physicians will definitely have its impact. It will require that prospective practitioners be more flexible in the choice of a specialty and in the location of their practice, and above all be very dedicated to their chosen profession.