Public policy and the supply of primary care physicians

Article Abstract:

Governmental policy and public money have a profound effect on the number of physicians being trained and on their ultimate choice of specialties and regions of the country in which to practice. In the 1960-70s Federal policy actively participated in increasing the number of physicians who entered primary-care practice. There is presently one physician for every 500 Americans, and the number of physicians is continuing to increase at a rate which is three times greater than the increase in the United States population. These statistics have encouraged changes in public policy and a general withdrawal of public funding from programs which influence geographic distribution of physicians. There is growing concern within the profession, however, that the number of primary-care physicians has been dramatically reduced. The 67,687 family- and general-practice physicians who were active in 1986 is less than half of the number who practiced in 1949. Coupled with this decline in manpower is a maldistribution of primary care physicians throughout the country. Historically rural areas have been especially dependent on the general practice physician, and although many family practice specialists have moved into more rural environments, the absolute number is less than the requirement of these communities. Increasingly, medical training has become economically dependent on income for the provision of service, and this fact ties the flow of money to more specialized tertiary-care facilities that are largely involved in training physicians to practice in medical and surgical specialties. The situation is only seen to be correctable by reform and adjustments of public policy, which will lead to the support of medical training for primary-care medical practice and in a correction of the current maldistribution of medical school graduates.

Evaluation, Finance, Practice, Family medicine, Medical policy, Health policy, Medical education

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How can we tell whether there are too many or too few physicians? The case for benchmarking

Article Abstract:

It appears that there will be an oversupply of physicians and the best way to prevent this may be to reduce US residency positions. A 1996 study used a technique called benchmarking to estimate the supply of US physicians. This involves comparing the supply of physicians to the normal staff of an HMO or hospital referral region. The supply of generalists and especially specialists exceeded this normal staffing pattern in many geographical areas. Reducing residency positions appears to be the most cost-effective way of reducing physician supply.

Editorial, Usage, Residents (Medicine), Benchmarks, Benchmarking

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The evolution of divergences in physician supply policy in Canada and the United States

Article Abstract:

Canada has effectively dealt with a projected physician oversupply and imbalance in physician distribution. After a 1991 report published by a commission of provincial ministers of health, most Canadian provinces cut back on the number of medical student enrollments, limited the number of international medical graduates applying for residencies and increased their focus on family medicine. In 1993, the Conference of Health Ministers proposed a national physician resource plan. The US has yet to develop such a plan.

Canada, Social policy

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