Medicine as a Career - Page 6
THE NEED FOR PHYSICIANS
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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 addi-
tional 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 anxi-
ety 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 conclu-
sions 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 condi-
tions, diminish. All the while the population
will undoubtedly continue to grow, increas-
ing the demand for medical services (already
being fueled by public health education
programs).
The aforementioned considerations may have
contributed to the significant down-
ward 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 to
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