PHYSICIAN SUPPLY: New Study Forecasts Generalist Glut
After years of warnings by health care analysts that there is a shortage of primary care doctors, the Boston Globe reports "surprising evidence that the nation now has too many primary care physicians." Further, the "surplus probably existed even while health planners were sounding alarms about shortfalls." "[H]undreds of new internists, pediatricians and other generalists have had difficulty landing work or only have found part-time jobs," according to a survey by the American Association of Medical Colleges soon to be published in the Journal of the American Medical Association. Dr. Michael Whitcomb, head of education programs at the American Association of Medical Colleges, said, "We thought that if medical students went into primary care, they would begin filling the need we perceived of inadequate numbers of primary care doctors. What our analyses suggest is that in recent years, there has been no insufficiency in primary care doctors. We were giving people the wrong message." According to Dr. Richard Cooper, director of the Health Policy Institute at the Medical College of Wisconsin, "We're at a point unlike the past, when physicians could decide what kind of doctor they wanted to be, where they wanted to do it and what they wanted to earn. Physicians now will have to be like anyone else, they'll have to go where the patients are. That's good for society but bad for physicians," he said (Tye, 4/13).
The National Resident Matching Program (NRMP) last month reported more medical school graduates chose to go into primary care than into specialties for the fourth year in a row -- a trend that reflects the nation's health care needs, according to the program. But many of these graduates who chose generalist residencies because of medical schools' warnings about the "glut" of specialists "are in for a shock," according to Dr. Jordan Cohen, president of the AAMC. The job market for primary care doctors "looks more like a surplus than a shortage," he said. The survey found that a little over 11% of the 1,590 residents going into the generalist field of internal medicine "had not yet landed a job, and another 7% agreed to part-time work or to a job in another specialty." The prospects were "nearly as bleak for pediatricians," but not as bad for family practice. But the survey's results do show that "previous estimates of a shortage of primary care doctors were erroneous," according to Whitcomb. "There are just some horror stories about the percent of those graduates who are not able to practice full time," he said. Further, if managed care holds good on its promise to cut costs, "as many as 40,000 more doctors could lose their jobs," according to Princeton University health economist Uwe Reinhardt.
Sorry For The Miscalculation
"Medical societies have been warning for a decade about a glut in doctors," the Globe notes. "But the presumption was that the oversupply was limited to specialists, and that there was a shortage of the kinds of primary care doctors that patients said they wanted and that managed care companies sought to help control costs." However, the Globe notes "there is a shortage in certain rural and inner-city areas." But if medical colleges had not sounded the alarm and urged graduates to go into primary care, "there probably would have been a severe shortage" of these doctors, according to Cooper. Medical school officials say the answer is to limit the number of foreign students vying for primary care positions in this nation. But Congress is reluctant to go along with these measures, possibly because lawmakers "hope that the surplus will encourage young doctors to move to areas that are underserved, lower their charges and spend more time with each patient."
The news implies "that the competition for patients is growing," and not just among doctors. According to the Globe, "the health care system is training three times as many nurse practitioners as it did a decade ago, along with many more chiropractors, osteopaths, acupuncturists and other health workers patients often visit instead of primary care doctors." Johns Hopkins School of Public Health professor Jonathan Weiner said, "We're seeing in every state turf wars between these groups, and they will increase" (Tye, 4/13).