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Update on the Physician Workforce August 2000
The full version of this resource paper is available in PDF format
COGME has issued a series of reports to fulfill its charge to recommend appropriate Federal and private sector efforts to address identified needs with respect to physician workforce trends, training issues, and financing polices. In particular, COGME has assessed the supply and distribution, both specialty and geographic, of physicians and the adequacy of data bases to support informed analyses and policy determinations relevant to these issues. These issues have been reviewed in two recent reports:
b. The Fourteenth Report, issued March 1999,2 expanded upon the need for continued programmatic support by encouraging the Federal government, the medical education community, and the States to "foster a more effective marketplace for the training of physicians by expanding the collection and dissemination of data on supply, need, and demand for physicians by specialty and region." (Recommendation 1)
This document is a compendium of three papers COGME commissioned for the purpose of exploring further those critical policy issues relevant to assessing current and foreseeable future physician workforce needs:
The papers described are as follows:
Estimates of Physicians Needed to Supply Underserved Americans Adequately Until Universal Coverage
Increasing Numbers of Family Physicians- Implications for Rural America
Physicians in the Public Health Workforce
The paper by Libby and Kindig and the Colwill and Cultice paper examine opposite sides of the generalist physician availability issue, the former focusing on requirements, the latter on supply. An important aspect of Libby and Kindig's work is the application of a sensitivity analysis of six potential scenarios for the American health care marketplace. These scenarios portray adjustments to potential changes in insurance coverage or staffing patterns.
The analysis conducted by the authors addresses two sets of issues:
Colwill and Cultice's paper involves a sensitivity analysis of a different sort. Through an extrapolation of recent trends in the number of residency graduates in family medicine, coupled with historic data concerning gender-specific attrition rates, gender-specific decisions to practice in rural areas, and other issues affecting supply, the authors arrive at family physician supply projections through the year 2020 both for the country as a whole and for rural areas specifically. They then explore the impact upon supply of two alternative scenarios: a five-year decline, at the rate of 200 per year, in the number of family practice residency graduates in the United States; and an analogous increase over five-years.
The Glass paper addresses two additional items of concern in today's health sector environment in which there is an increasing emphasis on population health and preventive strategies: (a) the paucity of physicians in the Nation's public health workforce and (b) the relative inadequacy of data concerning them. Noting such markers as the declining percentage of physicians enrolled in schools of public health, the extremely low percentage of local health departments headed by physicians, and the increasing need for physician faculty trained in research and teaching in schools of medicine and public health, the author recommends several initiatives designed to increase the number of physicians in public health/preventive medicine. One recommendation is to learn more about physicians currently in this workforce by conducting an in-depth enumeration study of the public health functions these physicians perform.
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