The nation's physician workforce : options for balancing supply and requirements / Committee on the U.S. Physician Supply ; Kathleen N. Lohr, Neal A. Vanselow, and Don E. Detmer, editors.

Format:

Book

Author/Creator:

Institute of Medicine (U.S.). Committee on the U.S. Physician Supply.

Contributor:

Lohr, Kathleen N., 1941-

Vanselow, Neal A. (Neal Arthur)

Detmer, Don E.

Language:

English

Subjects (All):

Physicians--Supply and demand--United States.

Physicians.

Medical policy--United States.

Medical policy.

Health planning--United States.

Health planning.

Physical Description:

xii, 109 p. : ill.

Edition:

1st ed.

Place of Publication:

Washington, D.C. : National Academy Press, 1996.

Language Note:

English

Summary:

Enormous changes are occurring in the organization and financing of the U.S. health care system--rapid changes that are being driven by market forces rather than by government initiatives. Although it is difficult to predict what they system will look like once it begins to stabilize, the changes will affect all components of the health care workforce, and the numbers and types of health care professionals that will be needed in the future--as well as the roles they will fill--will surely be much different than they were in the past. Despite numerous studies in the past 15 years showing that we might have more doctors than we need, the number of physicians in residency training continues to grow. At the same time, there is evidence that the demand for physician services will decrease as a result of growth of managed care. All of this is evidence that the demand for physician services will decrease as a result of growth of managed care. All of this is taking place at a time when, coincident with the result of failure of comprehensive health care reform, there is no coordinated and widely accepted physician workforce policy in the United States. The present study examines the following three questions: (1) Is there a physician policy in the United States? (2) If there a surplus, what is its likely impact on the cost, quality, and access to health care and on the efficient use of human resources? (3) What realistic steps can be taken to deal with a physician surplus? December

Contents:

The Nation's Physician Workforce: Options for Balancing Supply and Requirements

Copyright

Preface

Acknowledgments

Contents

The Nation's Physician Workforce: Options for Balancing Supply and Requirements

Summary

U.S. PHYSICIAN SUPPLY AND REQUIREMENTS

RELATIONSHIP OF PHYSICIAN SUPPLY TO KEY ELEMENTS OF THE HEALTH CARE SYSTEM

STRATEGIES FOR ADDRESSING PHYSICIAN SUPPLY ISSUES

Producing Physicians from U.S. Medical Schools

Revamping Graduate Medical Training

Controlling IMG Numbers through GME

Replacement Funding for IMG-Dependent Hospitals

Data Collection and Information Dissemination

CONCLUDING STATEMENT

1 Introduction

THE PHYSICIAN WORKFORCE

THE MATCH-OR MISMATCH-BETWEEN SUPPLY AND REQUIREMENTS

ORIGINS AND ORGANIZATION OF THE STUDY

Charge to the Committee and Project Activities

Related Issues

Principles Underlying Committee Conclusions and Recommendations

ORGANIZATION OF THIS REPORT

2 U.S. Physician Supply and Requirements: Match or Mismatch?

PHYSICIAN WORKFORCE ISSUES SINCE WORLD WAR II

General Issues

Pre-1980s Era

Current Status

Physician Workforce Trends

Overall Trends in Supply

Trends in Graduate Medical Education

METHODS OF ESTIMATING PHYSICIAN SUPPLY, PRODUCTIVITY, AND REQUIREMENTS

Physician Supply

Physician Productivity

Physician Requirements

THE FUTURE REQUIREMENT FOR PHYSICIANS

Factors That Could Increase Requirements

Factors That Could Decrease Requirements

Managed Care

Use of Nonphysician Personnel

INTERNATIONAL COMPARISONS

MATCH OR MISMATCH?

Conclusions of Physician Workforce Studies

Evidence from the Marketplace

Physician Incomes

Other Evidence

CONCLUSION

NOTES

APPENDIX

A Brief Note on Managed Care

3 Relationship of Physician Supply to Key Elements of the Health Care System.

HEALTH CARE EXPENDITURES

Competition

Health Care Costs

ACCESS TO CARE

Geographic Distribution

Specialty Distribution

Summary Comment About Access to Care

QUALITY OF CARE

High Numbers of Physicians Overall

General Effects

Volume and Quality

Provider and Consumer Satisfaction

Specialist-Generalist Issues

Education and Training

Issues Relating to IMGs

Costs, Quality, and Physician Supply

Summary Comment

OTHER ISSUES IN PRODUCTION AND UTILIZATION OF THE PHYSICIAN WORKFORCE

Human Resources Considerations

Opportunities for Medical Careers

U.S. Policy and the World Output of Physicians

Future of Academic Health Centers

The Service-Training Link and IMG-Dependent Institutions

4 Strategies for Addressing Physician Supply Issues

DO NOTHING: THE FREE OR UNREGULATED MARKET APPROACH

INSTITUTE CENTRAL FEDERAL REGULATION

General Approaches to Planning and Managing Physician Supply

Committee Views

A CONSTRAINED MARKET APPROACH

Antitrust Considerations

Production of Physicians from U.S. Medical Schools

Revamp Graduate Medical Training

Reduce GME Positions Without Changing GME Funding

Reduce First-Year Residency Positions and Change The Approach to GME Funding

Disconnect Funding of Service Delivery From Physician Training

Specific Controls on Immigration

Central Government Regulation

Controlling IMG Numbers Through GME

References

APPENDIX Biographies of Committee Members.

Notes:

Bibliographic Level Mode of Issuance: Monograph

Includes bibliographical references.

ISBN:

9786610192168

9780309175890

0309175895

9781280192166

128019216X

9780309588904

0309588901

9780585001838

0585001839

OCLC:

923262779