Report Counters ‘Anecdotes’ about State’s Physician Exodus

No evidence exists to support anecdotes about "large numbers of doctors" leaving California, according to a report released this week by the University of California-San Francisco Center for Health Professions' California Workforce Initiative. The initiative receives funding from the California HealthCare Foundation and the California Endowment (UCSF release, 4/4). The report, "The Practice of Medicine in California: A Profile of the Physician Workforce," complied data from the American Medical Association Masterfile and a 1998 survey of nearly 2,000 physicians statewide. According to the report, the ratio of physicians to the general population has increased from 177 doctors for every 100,000 people in 1994 to 190 per 100,000 in 2000. The 2000 ratio exceeds the requirements estimate established by the Council on Graduate Medical Education, the report says. Other findings from the report include:

More than one-third of California's active patient-care physicians are family practitioners, general practitioners, general internists or general pediatricians, while the remainder are specialists. The report says the findings "refute" allegations that California has too many general physicians and too few specialists.
The ratio of physicians to the general population ranges from 238 physicians per 100,000 residents in the Bay area to 120 per 100,000 residents in the South Valley/Sierra region, dispelling the notion that doctors are leaving the state's urban centers.
In 1998, nearly half of generalists and one-third of specialists in urban areas said that the majority of their patients were enrolled in managed care, challenging the idea that doctors are "shunning managed care" ("The Practice of Medicine in California: A Profile of the Physician Workforce," February 2001).
The median incomes for California doctors are between $120,000 and $250,000, "comparable" to incomes reported for other doctors and "well above" California's mean income of $33,000 -- indicating that doctors' earnings are not "plummeting."

Dr. Kevin Grumbach, UCSF associate professor of family and community medicine and the study's co-principal investigator, added that while California has more specialists than generalists, specialist growth was lower in recent years compared to generalist growth. He added, "The data indicate that public policy and the managed care environment in California may have had a modest effect on slowing the rate of growth of specialists relative to the rate of growth for generalists. However, the magnitude of this effect falls well short of the suggested mass exodus of specialists in California" (UCSF release, 4/4). To view the report, go to http://www.futurehealth.ucsf.edu/pdf_files/PHASS.pdf. Note: You will need Adobe Acrobat to view the report.

Ruffling Feathers?

The findings are likely to "rankle" the medical community, particularly those in the Bay area, where pratices have had difficulty recruiting new physicians, the San Jose Mercury News reports. In a joint statement, the Santa Clara County and California medical associations said they "disagree with the notion that California is not suffering from a 'brain drain' phenomenon wherein many physicians are leaving the state, leaving the practice of medicine or retiring." In addition, the Mercury News reports that the findings should be "viewed with caution" because they were largely drawn from 1998 data (Feder, San Jose Mercury News, 4/5).

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