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Predicted Doctor Shortage Not Inevitable

Researcher says more efficient practices by health providers could avoid problem

TUESDAY, Feb. 10, 2004 (HealthDayNews) -- For years, health experts have been predicting a shortage of doctors in the United States, due, in part, to the aging population.

But a new study by a Johns Hopkins University researcher concludes the country will have more than enough physicians to meet demand in the coming years -- if health-care providers operate more efficiently.

The study, by Jonathan P. Weiner, a professor of health policy and management in the Hopkins School of Public Health, appears in the current online edition of Health Affairs.

"This demonstrates that care can be provided much more efficiently," Weiner says. "There's no question that high-quality care can be delivered with far fewer physicians than we have currently."

Several recent studies have suggested that significant shortages of physicians will develop in the next two decades. And the U.S. Council on Graduate Medical Education has recommended that medical schools increase enrollments by 15 percent over the next decade to increase the supply of doctors.

Weiner bases his conclusion on a comparison of the supply of U.S. physicians and staffing at eight large medical group practices serving more than 8 million HMO members.

The medical groups, which serve members of Kaiser Permanente and two other HMOs, have a physician-to-patient ratio that is 23 percent to 37 percent below the national rate, the study found. For primary-care physicians, the medical groups have 25 percent lower ratios; for specialists, 32 percent lower.

Weiner acknowledges that staffing needs in the coming years will be influenced by shortages in some specialties and geographic areas, the graying of patients and physicians, and the increasing number of women doctors.

But, he says, "It certainly is not an issue of creating more physicians. It is an issue of getting physicians where they're needed. It is not an issue of availability; it's an issue of accessibility."

The solution, Weiner says, doesn't lie in simply increasing the number of medical school slots, as some suggest. He notes that taxpayers ultimately subsidize the training of doctors -- to the tune of a $500,000 to $1 million per physician. That includes Medicare subsidies to residency programs and taxpayer-financed subsidies to state medical schools, he says.

"U.S. policymakers should deliberate carefully before concluding that expansion of medical training programs is warranted, especially given the huge taxpayer subsidy associated with supporting the training of each new medical professional," Weiner says.

Redirecting some of that money could help provide health insurance for some of the tens of millions of Americans who have none, Weiner says. He also suggests linking aid to medical schools to stipulations such as having doctors spend a few years in rural or urban areas to help ease geographic physician shortages.

For the study, Weiner focused on patient-staff ratios during late 2001 and early 2002 at medical groups of Kaiser Permanente as well as the Groups Health Cooperative of Puget Sound in Washington state and HealthPartners in Minnesota. The medical groups provided care at 350 clinics and 33 hospitals owned and staffed by HMOs in nine states and the District of Columbia.

Weiner's study is drawing both praise and concern from some medical experts.

Edward Salsberg is executive director of the Center for Health Workforce Studies at the School of Public Health at the University at Albany of the State University of New York. He says the medical groups in Weiner's study provide valuable lessons on how to use physicians effectively and efficiently.

But Salsberg, who wrote a separate article on physician staffing that appears in Health Affairs, argues that staffing ratios at the medical groups can't be applied to the U.S. medical system as a whole.

"Using the workforce needs of a model system of care used by a small segment of the U.S. population to guide physician production for the whole country is inappropriate and could lead to major shortages, access problems and public dissatisfaction," Salsberg writes.

In assessing physician supply, Salsberg notes, the Hopkins study made adjustments for factors such as differences between the scope of care and patient populations for the entire U.S. patient population and those served by the medical groups.

Such adjustments, however, may not fully reflect the differences, Salsberg suggests. He points out that most HMO enrollees served by the medical groups are employed, and says that may limit the proportion of people with chronic illnesses.

Salsberg also says that unlike most physicians in the medical groups serving HMO members, many of those in the general physician population are involved in clinical research. They also include doctors who are teaching medical students and residents, as well as those caring for more critically ill patients as well as homeless people and illegal immigrants.

"It is important to learn how [the medical groups] get by, how they manage to provide good care," he says. "I think the lesson we need to learn is how they do that -- and not just take their numbers and apply them to how many doctors we need in America."

More information

To view the complete Hopkins study, go to Health Affairs. For more on the supply of and demand for U.S. doctors, visit the American Medical Association's American Medical News.

SOURCES: Jonathan P. Weiner, Ph.D., professor, health policy and management, and deputy director, Health Services Research and Development Center, Johns Hopkins Bloomberg School of Public Health, Baltimore; Edward Salsberg, MPH, executive director, Center for Health Workforce Studies, School of Public Health, University at Albany of the State University of New York; Feb. 4, 2004, online edition, Health Affairs
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