Future Supply Of Physicians Research Articles

Will the Real Physician Retirees Please Stand Up?

Policy makers and health workforce planners rely on counts of practice licences as a measure of the size of the active physician workforce. We use a population-based approach to correlate estimates of retirement from clinical care based on these data with those produced using physician payment data. We find that licensure data generates per-capita estimates of physician supply in British Columbia that are substantially higher than activity-based estimates. Licensure data are unlikely to produce reliable estimates of the timing and extent of physician retirement and therefore should not be used as the primary basis for estimating current or future physician supply.

Future projection of the physician workforce and its geographical equity in Japan: a cohort-component model

IntroductionThe geographical inequity of physicians is a serious problem in Japan. However, there is little evidence of inequity in the future geographical distribution of physicians, even though the future physician...

Patterns of physician retirement and pre-retirement activity: a population-based cohort study.

Knowing when physicians retire and how they practise in the pre-retirement years is important information for health human resource planning. We identified patterns of retirement for physicians in British Columbia and the determinants of when and how physicians retire. For this population-based retrospective cohort study, we used administrative data to examine activity levels and to identify retirements among BC's practising physicians. We included all physicians who were at least 50 years of age as of March 2006 and who had received payments for clinical services in at least 1 year between 2005/06 and 2011/12. We defined retirement as a permanent drop in monthly payments to less than $1667/month ($20 000/yr). We examined the patterns and timing of retirement by age, sex, specialty and location using linear and logistic regression models. Of the 4572 physicians who met the inclusion criteria, 1717 (37.6%) retired during the study period. The average age at retirement was 65.1 (standard deviation 7.8) years. Controlling for other demographic and practice characteristics, we found that women and physicians working in rural areas retired earlier, by 4.1 (95% confidence interval [CI] -4.9 to -3.2) years and 2.3 (95% CI -3.4 to -1.1) years, respectively. We found no difference in retirement age by specialty. We identified 4 patterns of pre-retirement activity: slow decline, rapid decline, maintenance and increasing activity. About 40% of physicians (440/1107) reduced their activity levels by at least 10% in the 3 years preceding retirement. During the study period, physicians in BC - particularly women and those in rural areas - retired earlier than indicated by licensure and survey data. Many physicians reduced their practice activity in the pre-retirement years. These trends indicate that forecasts relying on licensure "head counts" are likely overestimating current and future physician supply.

Forecasting the regional distribution and sufficiency of physicians in Japan with a coupled system dynamics\u2014geographic information system model

BackgroundIn Japan, the shortage of physicians has been recognized as a major medical issue. In our previous study, we reported that the absolute shortage will be resolved in the long term, but maldistribution among specialties will persist. To address regional shortage, several Japanese medical schools increased existing quota and established “regional quotas.” This study aims to assist policy makers in designing effective policies; we built a model for forecasting physician numbers by region to evaluate future physician supply–demand balances.MethodsFor our case study, we selected Hokkaido Prefecture in Japan, a region displaying disparities in healthcare services availability between urban and rural areas. We combined a system dynamics (SD) model with geographic information system (GIS) technology to analyze the dynamic change in spatial distribution of indicators. For Hokkaido overall and for each secondary medical service area (SMSA) within the prefecture, we analyzed the total number of practicing physicians. For evaluating absolute shortage and maldistribution, we calculated sufficiency levels and Gini coefficient. Our study covered the period 2010–2030 in 5-year increments.ResultsAccording to our forecast, physician shortage in Hokkaido Prefecture will largely be resolved by 2020. Based on current policies, we forecast that four SMSAs in Hokkaido will continue to experience physician shortages past that date, but only one SMSA would still be understaffed in 2030.ConclusionThe results show the possibility that diminishing imbalances between SMSAs would not necessarily mean that regional maldistribution would be eliminated, as seen from the sufficiency levels of the various SMSAs. Urgent steps should be taken to place doctors in areas where our forecasting model predicts that physician shortages could occur in the future.

Comparison of Physician Workforce Estimates and Supply Projections

Estimates of physician supply in the United States have been based on data that may overestimate the number of older physicians in the workforce. To compare physician workforce estimates and supply projections using the American Medical Association Physician Masterfile (Masterfile) data with estimates and projections using data from the US Census Bureau Current Population Survey (CPS). Parallel retrospective cohort analyses of employment trends of the number of active physicians by age and sex using annual data from the Masterfile and the CPS between 1979 and 2008. Recent workforce trends were used to project future physician supply by age. Annual number of physicians working at least 20 hours per week in 10-year age categories. In an average year in the sample period, the CPS estimated 67,000 (10%) fewer active physicians than did the Masterfile (95% confidence interval [CI], 57,000-78,000; P < .001), almost entirely due to fewer active physicians aged 55 years or older. The CPS estimated more young physicians (ages 25-34 years) than did the Masterfile, with the difference increasing to an average of 17,000 (12%) during the final 15 years (95% CI, 13,000-22,000; P < .001). The CPS estimates of more young physicians were consistent with historical growth observed in the number of first-year residents, and the CPS estimates of fewer older physicians were consistent with lower Medicare billing by older physicians. Projections based on both the CPS and the Masterfile data indicate that the number of active physicians will increase by approximately 20% between 2005 and 2020. However, projections for 2020 using CPS data estimate nearly 100,000 (9%) fewer active physicians than projections using the Masterfile data (957,000 vs 1,050,000), and estimate that a smaller proportion of active physicians will be 65 years or older (9% vs 18%). The increasing proportion of female physicians had little effect on physician supply projections because, unlike male physicians, female physicians were found to maintain their work activity after age 55 years. Compared with the Masterfile data, estimates using the CPS data found more young physicians entering the workforce and fewer older physicians remaining active, resulting in estimates of a smaller and younger physician workforce now and in the future.

Estimation of physician supply by specialty and the distribution impact of increasing female physicians in Japan

BackgroundJapan has experienced two large changes which affect the supply and distribution of physicians. They are increases in medical school enrollment capacity and in the proportion of female physicians. The purpose of this study is to estimate the future supply of physicians by specialty and to predict the associated impact of increased female physicians, as well as to discuss the possible policy implications.MethodsBased on data from the 2004 and 2006 National Survey of Physicians, Dentists and Pharmacists, we estimated the future supply of physicians by specialty, using multistate life tables. Based on possible scenarios of the future increase in female physicians, we also estimated the supply of physicians by specialty.ResultsEven if Japan's current medical school enrollment capacity is maintained in subsequent years, the number of physicians per 1000 population is expected to increase from 2.2 in 2006 to 3.2 in 2036, which is a 46% increase from the current level. The numbers of obstetrician/gynecologists (OB/GYNs) and surgeons are expected to temporarily decline from their current level, whereas the number of OB/GYNs per 1000 births will still increase because of the declining number of births. The number of surgeons per 1000 population, even with the decreasing population, will decline temporarily over the next few years. If the percentage of female physicians continues to increase, the overall number of physicians will not be significantly affected, but in specialties with current very low female physician participation rates, such as surgery, the total number of physicians is expected to decline significantly.ConclusionAt the current medical school enrollment capacity, the number of physicians per population is expected to continue to increase because of the skewed age distribution of physicians and the declining population in Japan. However, with changes in young physicians' choices of medical specialties and as the percentage of female physicians increases, patterns of physician supply will vary between specialties. Specialties less often chosen by young physicians and where males have dominated will face a decline in physician supply. These results highlight the necessity for developing a work environment that attracts female physicians to these types of specialties. This will also lead to improved gender equality in the workforce and more effective use of human resources.

Orthopaedic Surgeon Workforce and Volume Assessment for Total Hip and Knee Replacement in the United States: Preparing for an Epidemic

Iorio, Richard MD1; Robb, William J. MD2; Healy, William L. MD1; Berry, Daniel J. MD3; Hozack, William J. MD4; Kyle, Richard F. MD5; Lewallen, David G. MD3; Trousdale, Robert T. MD3; Jiranek, William A. MD6; Stamos, Van P. MD2; Parsley, Brian S. MD7 Author Information

Forecasting the global shortage of physicians: an economic- and needs-based approach.

Global achievements in health may be limited by critical shortages of health-care workers. To help guide workforce policy, we estimate the future demand for, need for and supply of physicians, by WHO region, to determine where likely shortages will occur by 2015, the target date of the Millennium Development Goals. Using World Bank and WHO data on physicians per capita from 1980 to 2001 for 158 countries, we employ two modelling approaches for estimating the future global requirement for physicians. A needs-based model determines the number of physicians per capita required to achieve 80% coverage of live births by a skilled health-care attendant. In contrast, our economic model identifies the number of physicians per capita that are likely to be demanded, given each country's economic growth. These estimates are compared to the future supply of physicians projected by extrapolating the historical rate of increase in physicians per capita for each country. By 2015, the global supply of physicians appears to be in balance with projected economic demand. Because our measure of need reflects the minimum level of workforce density required to provide a basic health service that is met in all but the least developed countries, the needs-based estimates predict a global surplus of physicians. However, on a regional basis, both models predict shortages for many countries in the WHO African Region in 2015, with some countries experiencing a needs-based shortage, a demand-based shortage, or both. The type of policy intervention needed to alleviate projected shortages, such as increasing health-care training or adopting measures to discourage migration, depends on the type of shortage projected.

U.S. Health Care and the Future Supply of Physicians

U.S. Health Care and the Future Supply of Physicians

Projecting physician supply at a state level: physicians in Louisiana in 2001 and 2006.

Many studies predicting physician supply are based on national statistics, which may not be applicable at the state level. To facilitate meaningful planning of future physician supply in our state, we developed a conservative, population-based projection of the total number of generalist and specialist physicians who will practice in Louisiana per 100,000 population in 2001 and 2006. Our projections, which err toward our goal of overestimating physician supply, indicate that the total physician number per 100,000 population in Louisiana will rise from the current level of 139 to 162, then to 186, in 2001 and 2006, respectively. The number of primary care physicians will rise from 52 to 59, then to 67, and specialists from 87 to 103, then to 119, in 2001 and 2006, respectively. These numbers are well within the range of need reported in several widely published demand scenarios used for comparison. In planning future policies on physician supply, states should develop their own projections rather than simply extrapolating national data to their individual situations.

The future supply of physicians.

Many health services researchers point to a growing surplus of physicians by the end of the century. The author discusses in detail a variety of policy positions, from the Flexner Report onward, that have affected the present and projected supplies of U.S. physicians. These include the American Medical Association's decades of efforts to control the numbers and types of U.S. medical students; effects of Medicare and Medicaid; changes in immigration and naturalization laws that increased the number of international medical graduates (IMGs); the medical community's non-response to the 1981 GMENAC Report's forecasts on physician oversupply; growth in the numbers of specialists; the fall and subsequent rise in the numbers of applicants to medical schools; the changing composition of the physician workforce; the refusal of the medical profession to consider a shorter training period for physicians; and other events from the past that can inform today's policymakers. The author then evaluates four policy recommendations that have evolved to deal with the problem of physician oversupply, and concludes that (1) reliance on the market to contain physician supply is unwarranted; (2) there is little prospect that Congress will soon reduce the inflow of IMGs, and even if it did, such action would have a marginal effect; (3) there is no prospect that 20-25% of U.S. medical schools will be closed by 2005, since the forces militating against such action are overwhelming; and (4) it remains to be seen whether the new health care environment will have more than a marginal effect in altering the current ratio of primary care to specialist physicians in the years ahead. In fact, if future outlays for health care increase as predicted, there should be sufficient funds for physician supply to continue to grow and for specialists to continue to make good incomes.

Domestic Production vs International Immigration

To determine alternate combinations for reductions in US medical school graduates (USMGs), international medical graduate (IMG) immigration, and graduate medical education (GME) residencies, based on future physician supply targets. A demographic projection model of the physician supply was constructed and calibrated to fit observed American Medical Association Physician Masterfile data and current supply forecasts. Total annual input to GME was backcast from given future supply targets, adjusting for the portion of IMGs in GME who do not enter the US workforce. The annual number of new physicians added to supply from domestic or international sources needed to reach future physician-to-population ratio targets. Because of the low rate of attrition from the physician supply, it takes up to 50 years for workforce policy to effectively stabilize the physician-to-population ratio at a target level. All target ratios considered here would require immediate reductions in the total number of GME positions. These reductions must be followed by gradual annual increases to account for population growth. The size of USMG and IMG reductions are interrelated and depend critically on the percentage of IMG trainees who remain to practice in the United States. Reductions in future physician supply can come from either the IMG or USMG component of physician production, or both. The model developed here allows the estimation of multiple combinations of both GME components.

Projections of physician supply in internal medicine: A angle-state analysis as a basis for planning

Physician supply planning has become an issue of increasing national debate over the past decade, particularly with the recent focus on health care reform. Most authorities agree that the United States has an increasing surplus of physicians. The physician supply debate focuses on how to determine current and future physician supply and define appropriate specialty mix needs and then choose the measures that will appropriately influence the current and future size and specialty mix of the physician workforce. We examine these issues in the context of internal medicine in Connecticut, which may provide a single-state model for physician supply planning. Data on the past and current supply of Connecticut internists and projections for future supply and need are examined. Particular attention is given to adult primary care (provided largely by general internists) and public policy implications. We find Connecticut has a disproportionate number of internists compared with the nation. Further, internist supply is growing faster than the population. Almost all subspecialties are in surplus and projected to increase further by the year 2000. Several approaches are available to limit excesses and produce more primary care physicians, including controls on residency and fellowship positions. Each approach presents both opportunities and challenges, and their implications must be carefully considered.

A national health work force policy. American College of Physicians.

This position paper highlights the need for a national policy for the health work force in general and supports the creation of a national commission to better coordinate the supply and distribution of health care workers to meet the nation's health care needs. It acknowledges that although there are no definitive data on the optimal mix of physicians, the nation should at least set a preliminary goal of achieving a 50/50 balance between specialists and generalists. Previous efforts to reverse the trend of decreasing numbers of medical students choosing careers in primary care have failed. A combination of legislative, regulatory, and voluntary incentives is now required. A national commission should be established to help develop and coordinate federal work force policies for the health professions. It would set targets for the aggregate numbers of physicians by specialty and would allocate residency and fellowship training positions to match future physician supply with requirements. The American College of Physicians emphasizes that the commission should be structured to include members, including physicians, who are knowledgable about graduate medical education and that it should be insulated from political considerations as much as possible. Controlling the number of residency and fellowship training positions among specialties and linking total postgraduate year-1 positions to the output of U.S. medical schools would substantially affect redirecting the future supply of physicians. The College offers eight principles for allocating postgraduate training positions. quality should be the strongest determinant. Local needs and minority representation must also be considered. Service needs should not dictate the number of training positions, but special arrangements are necessary to allow public hospitals in major urban centers to reduce their dependence on housestaff for meeting patient service needs. The roles and number of nonphysician health care providers must be considered. Private sector accreditation bodies such as the Accreditation Council for Graduate Medical Education should recommend allocations of training positions based on the quality of training programs. Allocation decisions should be made in advance so that disruptions for programs and residents are minimized. The allocation process, including the national work force commission, should be subject to external review.

How Many Physicians Can We Afford?

We project physician costs for the year 2,000 under several alternative scenarios, using different assumptions about the future supply of physicians and gross income (or expenditures) per physician. The supply of active, posttraining patient-care physicians is projected to increase from a ratio of 144 per 100,000 population in 1986 to 176 per 100,000 in 2,000. Depending on whether expenditures per physician increase at the rate of the consumer price index, the gross national product, or the historical 1982 through 1987 expenditure trends, there will be an additional cost (in constant 1986 dollars) of $21 billion, $30 billion, or $40 billion, respectively, compared with projected physician costs under a scenario of a constant physician-to-population ratio. The disproportionate growth of costs for practice overhead will pose a particular problem for efforts to restrain inflation of expenditures per physician.

Specialization Among Obstetrician/Gynecologists: Another Dimension of Physician Supply

This study uses the Herfindahl index to investigate the specialization patterns of physicians. "Specialization" is defined as the degree to which an individual doctor concentrates his practice into a narrow range of disease categories. This application is the specialization pattern of office-based obstetrician/gynecologists in the United States. Physician's age and solo practice both exhibit a systematic negative effect on specialization. Both the age and type of practice effects reflect the tendency for younger and nonsolo obstetrician/gynecologists to gear relatively more of their practice into birth-related activities. The age effect is consistent with the hypotheses that either: (1) energy and/or skills for treating pregnancy become more scarce with age, or (2) there is a life-cycle pattern in the doctor/patient relationship with pregnancy serving as an entry point. Malpractice concerns may also contribute to this age effect. The nonsolo practitioner effect suggests the efficiency of multiple doctor practices for allocating physicians' time in activities with high hourly variability in demand. The method used to measure specialization can be extended to investigate other specialty categories and important issues regarding the future supply of physicians' services. These include the effects of an aging physician population and proposed changes in physician reimbursement.

On the Supply of Physicians

The congressionally created Council of Graduate Medical Education is conducting a study to assess the adequacy of the current and future supply of physicians in six specialties. The study is revising and updating the needs-based method used by the Graduate Medical Education National Advisory Committee and using this method to project the requirements for physicians for the next two decades. Projections on the supply of physicians will be based on the latest data from the federal government's Bureau of Health Profession's health manpower model. Previous physician manpower studies are reviewed to provide a historic perspective and a frame of reference for the variables, data sources, and assumptions being considered by the Council of Graduate Medical Education study.

Beyond GMENAC--another physician shortage from 2010 to 2030?

Since publication of the 1981 report of the Graduate Medical Education National Advisory Committee (GMENAC),1 much attention has been focused on the current and future supply of physicians in the United States. The following analysis will suggest that the policy debate over the supply of physicians has been shortsighted and that important demographic, social, and economic shifts between now and the year 2010 could affect the supply of doctors dramatically, resulting in a shortage. The GMENAC report suggested that by the year 2000 there will be 144,700 too many physicians, or a ratio of 247 doctors to every 100,000 persons, . . .

Estimating the impact of state manpower policy: a case study of reducing medical school enrollments.

Perceptions of an impending oversupply of physicians have prompted proposals to reduce medical school enrollments in a number of states. Most of these states are also concerned with improving the specialty and geographic distribution of their medical manpower. The present study provides estimates of the effects of reduced numbers of in-state medical school graduates upon the future supply of physicians in Texas, and examines the medical school origin, medical specialty, and practice location of selected groups of Texas physicians. The results suggest that in Texas enrollment reductions would have no significant impact on physician supply over the next 15 years, and might actually prove counterproductive in altering physician distribution. The analysis of Texas data illuminates the unintended consequences likely to accompany a policy option that has been widely embraced by state officials largely on the basis of its intuitive appeal.

The future supply of physicians.

New and stronger pressures to reduce federal spending and growing concern within the medical profession that a surplus of physicians already exists or looms in some regions are focusing greater attention on the question of how many medical students the United States should be training. Certainly no consensus has emerged, but federal policies are increasingly based on the administration's assertion that a physician surplus already exists. Because the Reagan administration is determined to reduce federal responsibilities in the social sphere, however, the government has made little connection between the bountiful supply of practicing physicians and the opportunity to provide services . . .