Doctors, Dollars, and Determination: Making Physician Work-Force Policy

Prologue: More than a decade ago, the Graduate Medical Education National Advisory Committee asserted that the United States faced a future surplus of physicians because their annual production had doubled with the help of generous federal subsidies. Its report caused a stir at the time, but its overall impact on the nature of medical practice and on medical specialty distribution was minimal. It did provide the Reagan administration with a rationale for its decade-long inattention to workforce policy. Now, with a more activist administration in power and with the health care system moving toward more assertive forms of medical management, the subject of physician production and distribution has become more prominent. In this paper three federal executives, steeped in the specialized world of health work-force policy, detail the government's heavy investment in the education of health care professionals. Their message is that work-force policy must be an integral part of any broad-scale effort to reform the health care system, Fitzhugh Mullan, a physician who trained at the University of Chicago's medical school and in several New York City teaching hospitals, is the director of the Bureau of Health Professions (BHPr) in the Health Resources and Services Administration, Department of Health and Human Services, He formerly served as New Mexico's secretary of health and environment and was among the first physician recruits to serve in the National Health Service Corps (NHSC), which he later (1977-1981) directed. Marc Rivo trained in family medicine at Duke University and preventive medicine at the University of California, Berkeley, School of Public Health; he is director of the BHPr Division of Medicine, Robert Politzer holds a doctor of science degree from The Johns Hopkins School of Hygiene and Public Health, He is associate director for primary care policy at the BHPr, Abstract: Because managed care is likely to feature prominently in a reformed health care system, policymakers need to examine the impact managed care will have on medical practice, physician supply, and access to primary care providers. Goals for work-force reform should focus on five areas: (1) training physicians in the generalist disciplines of family practice, general internal medicine, and general pediatrics; (2) shaping the physician work force to reflect the nation's ethnic diversity; (3) distributing physicians in a geographically equitable way; (4) maintaining the current physician-to-population ratio rather than letting it continue to grow; and (5) establishing supply needs for nurse practitioners, primary care physician assistants, and certified nurse midwives.