Painful Readjustments Coming As Physician Supply Fails To Slow With Demand

"A rational national workforce policy is a half century overdue," says Jay Noren, Associate Professor at the University of Wisconsin's medical school at Madison, in a commentary that accompanies two studies that consider how managed care growth will affect the nation's demand for generalist and specialist physicians.

Dr. Noren describes the consequences of the policy vacuum as the neglect of a national workforce policy contributes to several major problems in the health care system:

• The mismatch between primary care physician supply and need reduces access to care for underserved populations.
• The absence of rational policy creates increased pressures for escalation of overall health care costs. A comparison of the differences among states in health expenditures has demonstrated that the number of specialist physicians per 100,000 population predicts higher expenditures.
• Medical education funding incentives contradict workforce needs.

• Establish an independent board with access to good data to make rational workforce decisions.
• Remodel Medicare funding to reduce incentives for teaching hospitals' excess residency positions and emphasis on training specialists.
• Provide direct Federal funding for both undergraduate and graduate medical education. Funding of education will reduce the dependency of medical schools on clinical revenues.
• Supplement the resident workforce in teaching hospitals with non-physicians, and assure payment for services offered by these providers.
• Address the problem of geographically underserved areas. Current measures are inadequate.
• Alter physician payment to favor primary care disciplines. He concludes that despite the trends and forces described in the accompanying papers, we cannot expect the financial incentives implicit in managed care to solve workforce problems quickly.

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