deemphasize specialization and strongly
encourage the expansion of the number of pri-
mary 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.
PHYSICIAN SUPPLY: CURRENT DEBATE
___________________________
A new major debate is developing over the issue
of physician surplus. It was fueled by a
report by a commission of health care policy
experts funded by the Pew Foundation.
The commission recommended that 20% of the
nation's medical schools be closed by
the year 2005. It warned of a surplus of
100,000 to 150,000 physicians in the next cen-
tury, and urged closing some schools as the
best way to solve the problem, although it
did not identify which schools should be shut
down.
The conclusion by the Pew commission that there
will be a surplus of physicians is
consistent with the earlier findings of other
organizations and the GEMENAC report
discussed above. Not surprisingly, there has
been a cool reaction by those in academic
medicine to the recommendation that schools be
closed. They advocate two other
courses of possible action, namely downsizing
schools and limiting access to graduate
training by foreign graduates. Currently, U.S.
schools graduate about 17,000 physicians
a year, but there are 24,000 first-year
graduate positions available. The 7,000 extra
spaces are filled by foreign medical graduates.
The commission did recommend that
graduate medical training be capped at 110% of
U.S. medical graduates. Some educa-
tors believe that solving the foreign graduate
problem by itself will resolve the issue and
downsizing will be unnecessary. This is because
they feel that once this number is
down, the marketplace will in a natural way
readjust the specialist-to-generalist ratio
and uneven geographic distribution of
physicians, thus eliminating surplus physicians.
One major element strongly impacts upon the
issue of physician surplus, namely
managed care. Since the number of specialists
will be reduced under managed care,
more physicians will enter primary care,
altering our health care system's infrastructure
more rapidly than expected.
More recently a total contradictory view on
physician supply has emerged, suggest-
ing that there may be a physician shortage by
the beginning of the next decade. The
rationale behind this suggestion is that (1)
the current population of physicians is aging;
(2) the workload for residents is diminishing,
generating a need for more of them; (3)
there is a markedly increased number of female
physicians with a prospective decrease
in lifetime work; and (4) the professional
activity work schedule of physicians is dmin-
ishing, but the need for medical services is
increasing. While these considerations are
resonable, a physician shortage may
nevertheless fail to materialize. This would be
comparable to the surplus that did not take
place toward the end of the twentieth century
as originally predicted.
The current serious difficulty in assessing the
future need for physicians is clearly
evident by the highly conflicting reports
published in recent times. On one hand, the
Council on Graduate Medical Education (CGME)
called for more medical schools to
help stem what it believes is a looming
physician shortage. This is a reversal of its prior
policy. The CGME has called for a 15% increase
in the number of medical school grad-
uates. The impetus for this decision was a
report by the Center for Health Workforce
Studies at the State University of New York at
Albany. The council predicted an 85,000
physician shortfall by 2020 at current
rates.
On the other hand, the General Accounting
Office (GAO) has come to a completely
opposite conclusion. In the study of the
nation's physicians' work force, the GAO found
that physician numbers grew at twice the rate
of the general population in the decade
between 1991 and 2001. Comparing data from the
AMA and the AOA against the U.S.
Census Bureau figures, the GAO determined that
all of the nation's statewide and rural
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