Physician supply predictions vary so wildly, it's no wonder Jonathan Weiner says he's still getting flak for his July 20 New England Journal of Medicine article that predicted an oversupply of 163,000 physicians-primarily specialists-by the year 2000.
Mr. Weiner, an associate professor of health policy and management at the Johns Hopkins University School of Public Health, estimates the country will have 376,000 specialists but will need only 225,000. Meanwhile, he foresees demand for 162,000 primary-care physicians and a supply of 174,000.
The research was commissioned by the federally chartered Council on Graduate Medical Education. It assumes that 40% to 65% of Americans will be receiving care from integrated, managed-care networks and that everyone will be covered by insurance. While the numbers appear ominous, some physician groups are far from panicked. "I put the...study in the same light as the study a few years ago that said we need more physicians. You make assumptions and maybe the assumptions aren't correct," said Richard Leer, M.D., president of the Marshfield Clinic, a multispecialty medical group based in Marshfield, Wis.
Randy Teach, Washington office director for the Medical Group Management Association, said: "I don't think this particular study has had any impact at all. It's too general."
It's hard to know what to believe. In 1988, researchers at the Rand Corp. and Tufts University predicted a shortage of 7,000 physicians by the turn of the century. It showed a need for 592,000 physicians, with 585,000 practicing.
That, in turn, conflicted with a 1980 report by the Graduate Medical Education National Advisory Committee, which forecast an oversupply of 144,700 physicians by 2000.
Mr. Weiner, who believes government should stem the flow of specialists from training programs, said he wants to draw attention to the need for a national physician supply plan. "I'm not going to say my numbers are exactly right," he said. "I'm going to say we need to look long and hard at what the numbers are."
He said specialists should lower their career expectations. That means working for HMOs, moving to small cities and rural areas, accepting lower pay and leading "more normal lives."