PHYSICIAN WORKFORCE: STUDY SUGGESTS NEW MEASUREMENT TOOL
Writing in this week's JOURNAL OF THE AMERICAN MEDICALThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
ASSOCIATION, researchers from Dartmouth Medical School's Center
for the Evaluative Clinical Sciences and the VA Medical Center in
White River Junction, VT, suggest a new way to estimate physician
workforce requirements for the U.S. Physician workforce
estimates are currently reached by one of two methods: needs-
based planning, which "relies on panels of experts to estimate
the per capita number of physicians needed to treat the diseases
managed by a given specialty," and demand-based planning, which
"uses current utilization as a proxy for patient demand and as an
indicator of physician requirements." The authors write,
however, that neither of these methods is a satisfactory way to
estimate future physician workforce requirements. The usefulness
of needs-based planning is limited by "the complexity of many
medical problems and the slow pace of outcomes research in
contrast to the rapid pace of technological change," while
demand-based planning "perpetuates current utilization" trends
and may lead to increased use of medical services.
WHAT NOW?: According to the authors, benchmarking may offer
a useful "alternative" method for estimating physician workforce
requirements. This method compares "physician resources with a
benchmark health plan or region" to provide a "guidepost." The
benchmarks are health plans or communities "that achieve low
levels of deployment of clinically active physicians without a
measured loss of patient welfare due to a shortage of
RESULTS: The authors measured the physician workforce in
306 regions and three health care systems: an HMO; Minneapolis,
with its highly competitive managed care market; and Wichita,
"because it provides an example of low workforce deployment in a
predominantly fee-for-service market." They found that the
"clinically active generalist workforce in the United States
(70.9 per 100,000) exceeded the benchmark HMO staffing level ...
by 35%," and the Wichita level by eight percent. However, "the
generalist workforce in Minneapolis ... was higher than the
United States as a whole." The U.S. specialist physician
workforce exceeded the three benchmarks examined in the study,
with the greatest difference in the Wichita benchmark.
FINDINGS: The authors note that the national implementation
of the Wichita fee-for-service benchmark would result in "the
greatest reduction in specialty workforce." They write that
"[i]t is also of interest that the HMO benchmark suggests an
excess of primary care physicians," and that "residency programs
may need to reexamine their growing emphasis on generalist
training" (Goodman, et al, 12/11 issue). Writing in an
accompanying editorial, Robert Wood Johnson Foundation President
Dr. Steven A. Schroeder says that what is new about the study is
its "detailed geographically based analysis that both
demonstrates the wide regional variation in physician staffing
... and provides local regions a sense of how they compare with
similar communities." He writes, "It thus adds a new way to
consider the adequacy of national and regional physician supply.
It also avoids the arbitrariness of setting up specific
percentage targets" (Schroeder, 12/11 issue).
PUT YOUR MONEY...: The Center for the Health Professions at
the University of California-San Francisco announced yesterday
that it will award 14 grants totaling nearly $300,000 to
organizations committed to implementing the regulatory reforms
recommended last year by the Pew Health Commission and its
Taskforce on Health Care Workforce Regulation (see AHL 10/5/95).
The reforms are intended to better guarantee the competence and
accountability of doctors, nurses and other health professionals.
Center Co-director Edward O'Neil, PhD, said, "The dynamic changes
in the health care system demand that the regulation of health
care professionals is also transformed. State legislators
everywhere are grappling with how to make the best use of limited
health care resources, and in the process, are reconsidering how
to regulate health care professionals" (Center for the Health
Professions release, 11/12).