The Physician Workforce

Do we have too many physicians? Too few? Should we be training more? Are they in the right places? Are they in the right specialties? For me, it's really hard to get a gestalt on these questions. I would guess that we have too few physicians; after all, I've been reading a lot on the news about the lack of doctors (especially primary care), and I know certain communities such as rural areas are underserved. I know there are proposals to increase the capacity of medical schools. But where's the data?

Interestingly, the COGME 16th report 2005 indicates the physician supply is slightly increasing; in 2000, there were 283 full time equivalents per 100,000 people, in 2005 there were 293 full time equivalents per 100,000 people. But as you would expect, the number of generalists has stayed fairly constant since the 1960s while the number of specialists has trended up. It's hard to estimate whether there's a shortage or surplus of physicians; how do we know what an ideal patient panel is for a primary care doctor? Do we use traditional economic forces of supply and demand to understand the various forces on the physician workforce? Furthermore, disparities are highly regional. Even in California, highly physician populated areas (the bay area, Los Angeles, Orange County) are next to areas with few physicians (inland empire, central California).

Yet the supply of physicians has stayed relatively constant; since 1980, the annual number of graduates of U.S. allopathic medical schools has been stable at 15-16,000. These make up 2/3 of residents; in 2005, international medical graduates made up 26% and osteopathic graduates made up 12%. Fewer and fewer internal medicine residents are choosing careers as generalists; in 1998, over half of residents wanted to be generalists while in 2005, only 20% did (Bodenheimer, NEJM 2006).

One can also analyze the supply in many different ways; the number of women and minority physicians is increasing. The empirical evidence suggests that to serve minority populations, we ought to train minority physicians, so this is an effective trend. In the end, I'm not sure how to interpret all this data. I think it would be difficult but helpful to expand medical school classes and start new medical schools, especially in areas with underserved populations. I think we need to turn more to allied health professionals like nurse practitioners and physician assistants to help fill primary care since the trends suggest making more physicians would lead to making more specialists.