HMO Enrollment Growth and Physicians: The Third Compartment

Prologue: Six years ago, the Graduate Medical Education National Advisory Committee (GMENAC) declared that by the year 2000, the United States would have a practicing physician population of 643,000-145,000 or 29 percent greater than the perceived requirement Despite the criticisms that have been leveled at its supply estimates, the 1980 report remains the standard work to which policymakers turn for data regarding future medical personnel needs. As chairman of the committee, Alvin Tarlov was the driving force behind its work, “the guy who made the whole thing fly,” in the words of one of the participants. In this essay, Tarlov takes another look at the physician supply issue in light of the rapidly changing medical care delivery system and concludes that the GMENACs physician supply estimates should be recalculated in light of proliferation of alternative delivery systems. Tarlov, who left the chairmanship of the Department of Medicine at the University of Chicago in 1984 to become president of the Henry J. Kaiser Family Foundation, has long been a recognized national expert on medical manpower issues, with a particular emphasis on internal medicine. Since assuming his new post, Tarlov and the Kaiser Foundations Board of Trustees have begun to move its philanthropic investments in several new directions, dramatically different than its traditional emphasis on health professions education and the organization and financing of health care. The major new direction is disease prevention and health promotion, with a focus on assisting grass roots community groups. The foundation also has created another new initiative since Tarlov's arrival, the Program to Improve Health Care Outcomes.