Study Questions Premise of Impending U.S. Physician Shortage

Staffing at HMO Medical Groups Shows that Efficient Care Requires Far Fewer Specialists

Physician groups, government agencies, and many U.S. medical schools are concerned with a potential physician shortage and are calling for an increase in the number of physicians trained each year. However, new research from the Johns Hopkins Bloomberg School of Public Health found that the current U.S. physician supply is large enough to meet the needs of patients. Jonathan Weiner, DrPH, the study’s author and a professor in the School’s Department of Health Policy and Management, compared the current supply of U.S. physicians with the staffing at several large medical group practices that treat health maintenance organizations (HMO) patients. He found that an increase in the number of physicians might not be necessary. His study, entitled “Prepaid Group Practice Staffing and U.S. Physician Supply: Lessons for Workforce Policy,” is featured in the Feb. 4, 2004, online issue of the journal Health Affairs.

“Over the last few years, a general consensus has developed among medical training institutions that there are not enough specialist physicians in the educational pipeline. The question of how many physicians a community needs has become quite controversial lately, and there has been precious little evidence to support this debate. By analyzing the number and types of doctors that serve the members of these HMOs, considerable light has been shed on this topic,” said Dr. Weiner.

Prepaid group practices (PGPs) are well organized multispecialty medical groups that are reimbursed by capitation to serve the enrollees of HMOs. They were among the first to establish coordinated approaches to care delivery, and to use nurse practitioners and physician assistants. Many of the characteristics of PGPs have been widely copied by other health care plans, even though the PGP model itself is still relatively new. 

The study included not-for-profit PGPs from six units of Kaiser Permanente, which is based in California, as well as the Group Health Cooperative of Puget Sound in Washington and HealthPartners in Minnesota. In total, 8 million consumers at 350 clinic sites and 33 prepaid group practice-staffed hospitals were studied between 2001 and 2002.

The study found that the HMOs had about 1 physician for every 650 patients, compared with the current U.S. practicing physician supply of 1 per 400. Also, the HMOs tend to make greater use of primary care physicians rather than specialists. However, the study did identify a trend at the HMOs suggesting that specialist services increased at a faster rate than generalist care over the last two decades.

According to the study, almost one-half of the PGP physicians were female, compared with only 22  percent of the current U.S. physician workforce. Dr. Weiner noted that today’s PGP gender ratio likely foreshadows the future situation, given that women now comprise about 50 percent of medical students. In addition, he said workforce planners should study the trend for women doctors to work fewer hours per week than their male counterparts.

“PGP medical groups are able to provide care to a patient population with considerably fewer physicians than are currently available in the U.S. All told, the physician-to-population ratios at the three PGPs studied were about 25 percent lower for primary care physicians and 32 percent lower for specialists. This evidence does not lend support to the premise that the current national supply of doctors is inadequate,” said Dr. Weiner.

He continued, “U.S. policymakers should deliberate carefully before concluding that expansion of medical training programs is warranted, especially given the huge taxpayer subsidy associated with supporting the training of each new medical professional. The taxpayer price tag is probably in the range of $750,000 per physician and we want to make sure we use those precious health care resources wisely.”

“Prepaid Group Practice Staffing and U.S. Physician Supply: Lessons for Workforce Policy” and accompanying editorials are available at www.healthaffairs.org

The study was supported in part by a grant from the Kaiser Foundation Health Plan.