Managed Care on the March: Will Physicians Meet the Challenge?

Prologue: For several years analysts of U.S. physician supply have predicted a coming surplus of physicians by the end of this century. Several trends in the health care marketplace have exacerbated this situation since the Council on Graduate Medical Education released its Third Report in 1992 warning of over-supply. Probably the most striking trend is the growing prevalence of managed care. Managed care plans have been found to use a higher proportion of generalist physicians and fewer specialists, which has led to several recent studies that reexamine the nation's physician supply needs. In a recent editorial in the Journal of the American Medical Association , Steven A. Schroeder wrote, “We may soon enter an era in which the market may force emerging specialists into careers that only faintly resemble what they had hoped for. Such an occurrence would be unfortunate for these physicians, for their patients, and for the nation.” This paper offers a fresh perspective on physician supply needs in a health care system dominated by managed care, from a team of authors from the Bureau of Health Professions. Sandy Gamliel, deputy chief of the Workforce Analysis and Research Branch, holds a degree in economics from the University of Maryland. Robert Politzer is chief of the branch and holds a doctorate in health services research from The Johns Hopkins University School of Hygiene and Public Health. Marc Rivo directs the bureau's Division of Medicine; he holds a medical degree from the University of California, San Francisco, and is on the medical teaching staffs of George Washington and Georgetown Universities in Washington, D.C. Fitzhugh Mullan is the bureau's director and serves as an assistant surgeon general in the U.S. Public Health Service. He holds a medical degree from the University of Chicago. Abstract: The health care delivery system in the United States is in transition. Increasingly managed care plans are gaining in predominance. The proliferation of managed care systems will have an impact on the demand and requirements for physicians. This paper attempts to project and estimate requirements for physicians in 2000 and 2020, assuming that the health care system will continue to be dominated by managed care. The projections are then compared to forecasts of physician supply under two separate physician production scenarios. The authors discuss the adequacy of the future physician workforce to provide services required by a health care system dominated by managed care.