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11. Physicians for the Future -- What are the Needs?
Pages 261-285

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From page 261...
... Private sector recommendations and federal legislation affecting recent growths Much of the expansion in physician supply in the late 1960s and early 1970s can be traced to concern expressed as early as l9S9 that the future supply of physicians would not be adequate for an increasing population unless new medical schools were constructed and the numbers of students in existing schools were increased.4 However, several years elapsed before the recommendations were buttressed by f ederal legislation -- the Health Professions Educational Assistance Act of 1963, whi ch provided funds for construction. Further alarms of an impending shortage of physicians were sounded in 1964 in the Coggeshall report to the Association of American Medical Colleges (AAMC ~ .
From page 262...
... Osteopathic school enrollments have grown at similar rates (Table 2 ~ . Enrollments in allopathic schools have fallen off slightly, as of the 1982/83 academic year, and are expected to remain at this reduced level or to continue a modest decline in the next few years.
From page 263...
... Chicago: American Osteopathic Association, 1982. Inflow of Foreign Medical School Graduates The annual inflows of F14Gs have been very uneven, reflecting changes in health manpower policies, and immigration and licensing policies (Table 3~.
From page 264...
... Chicago: American Medical Association, 1982. TABLE 4 Foreign Medical Graduate Participation in Graduate Medical Education, 1979 to 1981 .
From page 265...
... S . medical students entering allopathic schools would increase 2.5 percent per year between 1978/79 and 1981/82 and then remain constant at 18,151; that numbers entering osteopathic schools would increase 4.6 percent per year through 1987 and then remain constant at 1,868; and that numbers of FMGs entering residencies in the United States would increase to 4~100 by 1983/84 and then remain constant.
From page 266...
... ~i~2 Population 218, 717b 249,731C 267,990C 14: 171 215 240 26% NOTE: The major cause of difference between physician supply and projections in Tables 5 and 6 relates to the method by which the 70,000 residents in training are counted. The BHPr counted each resident as one physician, while GMENAC counted each resident as one-third of a full-time equivalent practicing physician.
From page 267...
... This same period witnessed the emergence of two new categories of health professionals-nurse practitioners (NPs) and physician assistants (PAs)
From page 268...
... o o o o o o ~o ~ ~ ~r - ~ o ~ ~ ~ ~ r~ o J ~e 000 0 0 O O O O O O e~ ~ _ ~ ~ 0 ~ ~ _ O - 0 -;r 00 0 0 0 0 00 0 0 0 0 O ~ ~ , ~ ~ ~ 0 r~ 0 ~ ~ 0` ~ O ~~ 0 ~ C _ 0 0 · · oao 0 ~ _.
From page 269...
... Difficulty of Estimating Requirements for Health Professionals Although manpower forecasting methods have become more sophisticated, improvements have been offset by a greater complexity of the manpower situation and a rapidly changing health care system. Long-term pro Sections are dependent on social, economic, and political assumptions based on "most-likely" scenarios in a rapidly changing health care system.
From page 270...
... Future need for health professionals is estimated by the incidence/prevalence of various illnesses requiring medical treatment; future need considers what ought to be consumed for the population to stay healthy. Demand involves the use of medical services largely as an economic decision.
From page 271...
... 3.2 patient visits per week respectively for physicians who did vs. did not employ NPs and PAs.18 Further uncertainty is related to the share of health care services that would be assumed by the growing number of health care providers in competition with physicians, e.g., nurse midwives competing with obstetricians, NPs with primary care physicians, psychologists with psychiatrists, optometrists with ophthalmologists, and so forth.
From page 272...
... According to a report from the National Academy of Sciences, labor market data show that personnel shortages continue in the clinical science f ields, primarily because of the strong demand in medical schools for faculty members to conduct research as well as teach and provide patient care, and the difficulty in recruiting young physicians for research careers .
From page 273...
... But there also is a growing demand for clinicians to participate in faculty practice plans, which are becoming ever more important in the economy of medical schools (Table 1, Chapter 8~. Most analyses project a need for clinical investigatory lid Medical school faculty that will continue to outstrip supply.
From page 274...
... . To the extent that these institutions promote and are able to achieve greater efficiency in health care delivery, requirements for health professionals will theoretically be reduced.
From page 275...
... The new physicians who are hired will have to abandon professional freedom in the economic sense and accept the restrictions of incorporated employment. Some Results of an Increasing Supply of Physicians As discussed above, the number of actively practicing physicians will be increasing sharply in the 1980s.
From page 276...
... The Physician Practice Study documented that institutional practice was the main practice for 15 percent of newly trained family physicians, 42 percent of primary-care-track general internists, 23 percent of general internists, and 31 percent of subspecialty internists.30 A likely scenario follows. The rapid rise in the number of physicians will provide the f inal impetus to complete the incorporation of health services.
From page 277...
... The 1967 projections of requirements for 1975 provides an example. While TABLF 8 Comparison of Pro Jections of Physlelan Supply and Requirements f or 195~' and 1975 Estimated Estimated Actual Study Requirements Supply Supply Projections for 1960 Ewing Report (1948)
From page 278...
... By using market definitions, a decline in real income indicates that supply has risen faster than demand. Net earnings for physicians have barely kept pace with inflation, and both practice hours and patient visits per week have declined (Table 9~.*
From page 279...
... Therefore, we recommend that there be a continuing effort to collect and analyze data, prepare biennial profiles of the supply and requirements for health services, issue five and ten year forecasts, and develop long-tenm health manpower policies and recommendations. This effort would involve a careful consideration of the rapidly changing health care system and the consequences of those changes for health manpower.
From page 280...
... -State legislatures, facing increased budgetary pressures, will want guidance on future levels of medical and other health professional school enrollments. States will need to determine their health-manpower needs, the distribution of existing providers by location and specialty, the inflow and outflow of health professionals, and the return rates on funds for health professions training.35 As they do, they will be greatly assisted by having available national data f or purposes of compari son.
From page 281...
... Neither group is, however, explicitly concerned with health professionals other than M.D.s. The AMA ant the ALEC are also Grieved as looking predominantly at the needs of the profession, although the needs of the public are also high on their agendas.
From page 282...
... The. Institute of Medicine Committee on National Needs f or Biomedical and Behavioral Research Personnel could provide extensive data and analyses for research manpower policy formulation.
From page 283...
... Current Population Reports, Pro Sections of the Population of the U.S.: 1982 to 2050 (advance report)
From page 284...
... G The Future Role of Non-Physician Health Professionals.
From page 285...
... Journal of Medical Education 53: 640-650, 1978.


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