The federal government needs to increase funding for community health centers and other safety-net providers and expand programs to encourage physicians to move to medically underserved areas, according to a medical education advisory panel.
The Council on Graduate Medical Education's report, which was released last week, said such programs have had a modest effect on reducing the undersupply of physicians and other clinicians in many rural and inner-city urban areas, but it is still a persistent problem.
That undersupply comes despite the continuing increase in the ratio of physicians to the general population, which has many experts declaring that the U.S. has too many physicians.
"This is a central paradox of the American healthcare system: shortage among surplus," said council Chairman David Sundwall, M.D.
The trouble in physician oversupply is in the number of subspecialists, who tend to settle in urban areas that already have adequate numbers of physicians, according to the council's report. Primary-care physicians tend to distribute themselves more evenly around the country, but U.S. medical schools are graduating fewer generalists than necessary, the council said.
The report noted a stabilization in the number of urban and rural areas with shortages of primary-care physicians.
The number of such areas has dropped to 2,597 in 1997 from 2,736 in 1994, although it is still higher than the 1,921 areas in 1980.
"The progress is frustratingly slow," said Lawrence Haspel, D.O., the council's vice chairman. "But we've got to continue our efforts to maintain the status quo and make some progress."
To increase the number of physicians in underserved urban and rural areas, the council encourages the government to expand funding for the National Health Service Corps -- which offers physicians scholarships or loan forgiveness if they locate in such areas -- and federally financed community health centers.
President Clinton's fiscal 1999 budget proposal has called for no increase in health service corps funding above its current $116 million budget. Clinton's health centers budget would increase by about 1.8%, to $841 million.
The report also called the continuing increase in the number of uninsured Americans as the biggest barrier to healthcare and calls for policies that will increase coverage.