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No Pending Physician Shortage: Study

Better use of existing doctors will meet nation's needs

TUESDAY, March 7, 2006 (HealthDay News) -- Despite dire predictions of a looming physician shortage, the United States has enough doctors to last through 2020, if they are used efficiently, a new study finds.

"It's not how many physicians there are, it's what the physicians do," said study author Dr. David Goodman, a professor of pediatrics and of community and family medicine at the Center for the Evaluative Clinical Sciences at Dartmouth Medical School.

A number of organizations, including the Association of American Medical Colleges, have been predicting a shortage of physicians -- largely as a result of the burgeoning elderly population -- and are calling for expanded enrollments at medical schools. An increased enrollment of 15 percent, translating into 3,000 more graduates each year, along with a removal of Medicare funding limits for graduate medical education, should ease the problem, they claim.

But quantity may not always equal quality, contend the authors of the new study, which appears in the March/April issue of Health Affairs. They found that regions and states with more medical specialists and general internists have lower quality of care, as measured by death rates and other performance standards.

Using the Medicare claims database, Goodman and his colleagues looked at the experiences of people at the end of life who received most of their medical care at academic medical centers. Then they analyzed how many physician hours were spent to care for patients during the last six months of their life.

"These were very standardized cohorts of Medicare patients so that we would know that the patient populations were similar," Goodman explained. "All the patients died and all were cared for at academic medical centers, which have high-quality care so the overt quality question was taken out of the study."

The number of physicians needed showed a 4.7-fold variation, from about six per 1,000 chronically ill patients to slightly more than 28 per 1,000.

Among 79 academic medical centers studied, New York University Medical Center in New York City had the highest total labor input, with 28.3 physician full-time equivalents per 1,000 patients in the six months before death.

At the lowest end of the scale, Medical College of Georgia used six physicians and the Mayo Clinic in Rochester, Minnesota, 8.9.

And while many centers using less labor were in smaller urban areas, many were in larger urban centers, such as the University of Cincinnati, the University of California, San Francisco, and the University of Minnesota.

"Rather than spending more resources on training more physicians, we should be focusing on building more efficient delivery systems," Goodman said. This would lead to improved quality of care and more efficient care, he stated.

"We share the author's concern about the variations in the delivery system, but we don't think it changes the need to increase the physician supply and medical education capacity in America," said Edward Salsberg, associate vice president of the Association of American Medical Colleges and director of the association's Center for Workforce Studies. "The reality is that the aging of the U.S. population, combined with the growth of the U.S. population, which is pretty significant, is going to lead to the physician-population ratio actually peaking in about 2016, just when baby boom generation hits 70. Even if we cut out inefficiencies, which will be very hard, we will need additional physicians."

But Goodman speculated that the academic medical centers that had the most efficient systems of care also had better information systems, sharing of electronic medical records and, generally speaking, more organized settings.

That means solutions already exist to start changing the health-care setting, he said.

"We have benchmarks. We have academic medical centers which are highly successful in terms of the care they provide, and we need to start looking to those places as our examples," Goodman said. "We need to study them and understand them and emulate them."

"The Mayo Clinic has been studied very extensively and is fairly well-understood," he continued. "We should be at a point where we can emulate some of those systems."

More information

Visit the Association of American Medical Colleges for the alternate viewpoint, on why more physicians are needed.

SOURCES: David Goodman, M.D., professor, pediatrics and community and family medicine, Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, N.H.; Edward Salsberg, associate vice president, Association of American Medical Colleges (AAMC), and director, AAMC Center for Workforce Studies, Washington, D.C.; March/April 2006 Health Affairs
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