More voices join debate on physician work force

At least two new studies support the position, now generally held by physician work force experts, that the United States will face a physician shortage in the next decade. The debate has heated up since October 2003, when the Council on Graduate Medical Education, a federal advisory group, endorsed a study that forecast a shortage of physicians by 2020, a reversal of past policy.

Most recently, a report from Merritt, Hawkins & Associates, a physician recruiting firm, says physicians are getting out of medicine at such a rapid pace that the net reduction in physicians soon will make it more difficult for patients to access care.

The report, "Survey of Physicians 50 to 65 Years Old," states that some 51% of respondents said they planned to make a change in their practices in the next one to three years that would reduce the number of patients they treat or take them out of patient care entirely.

"Many of those physicians in the 50-55 and 56-60 age groups, who are typically at the peak of their practices in terms of number of patients seen, will seek alternatives to patient care practice," the study said. "Should these peak-practice physicians retire, find work outside of patient care or significantly reduce their workloads, millions of patient visits per year will have to be absorbed by other physicians."

Of those planning to make a change, 40% said rising medical liability insurance rates were a motivating factor.

Specialty groups are also calling attention to shortages in their ranks. The Critical Care Workforce Partnership, made up of the American College of Chest Physicians, the American Assn. Of Critical-Care Nurses, the American Thoracic Society and the Society of Critical Care Medicine, is predicting a crisis in critical care services.

Richard Irwin, MD, president of the American College of Chest Physicians, said, "The baby boomers are a huge number of Americans who are very active and are getting older. As they age, the number of critically ill will increase. We're anticipating that the shortage of critical care health professionals will become critical by 2007."

In the April issue of Chest, partnership members outlined ways to address the impending shortage and called for policy-makers to take action. The group called for standardizing critical care practices to make the system more efficient. It suggests that the Health Resources and Services Administration could develop a model to estimate the appropriate physician/population ratio for critical care specialists and then seek to find ways to redistribute the current critical care work force based on these results.

Other measures the Critical Care Workforce says the government could take include eliminating the cap on graduate resident positions and expanding the ability of international medical graduates to practice in this field by including critical care as eligible for J-1 visa waivers.

Another view

Not everyone buys into the shortage theory. The authors of "Specialist Physicians Providing Primary Care Services in Colorado," published in the March Journal of the American Board of Family Practice, contend that talk of a surplus needs to be re-examined.

Their study found that many specialists in Colorado were providing primary care to have a full schedule.

The survey showed that 46.5% of the 2,745 specialist respondents reported having provided primary care services in the last week. As a group, 27.9% of specialist physicians' time was committed to primary care activities. The researchers estimated that specialists provided 33.5% of primary care services in the state. Extrapolating the data, they suggested that the nation might be getting a third of its primary care from specialists.

Robert Phillips Jr., MD, MSPH, one of the study's co-authors, said a surplus of specialists could be behind these numbers.

"In the case of Colorado, the demand by patients for specialty care was still not sufficient to fill up the specialists' time," he said, though another reason could be a failure to compete, since the specialists who were giving primary care tended to be those without board certification in their specialty.

At the very least, Dr. Phillips said, this survey has found an unanticipated dynamic that could play a large part in calculating physician work hours. At the most, the study pokes a big hole in physician shortage theories.

"This is initial evidence from one state that says [the shortage theory] doesn't hold up," Dr. Phillips said.

The survey asked Colorado's physicians how many hours in the last week they performed primary care services such as preventive care, routine physical exams or treatment for common ailments.

Richard Cooper, MD, director of the Medical College of Wisconsin's Health Policy Institute in Milwaukee, still believes a physician shortage is imminent. He said the Colorado survey likely was capturing the demands of treating patients with chronic problems too complicated to refer back to primary care doctors as opposed to showing that specialists are providing primary care to fill their schedules.