THE FUTURE-SUPPLY OF PHYSICIANS

Many health services researchers point to a growing sure plus of physi cians by the end of the century, The author discusses in detail a vari ety of policy positions, from the Flexner Report onward, that have aff ected the present and projected supplies of U.S, physicians. These inc lude the American Medical Association's decades of efforts to control the numbers and types Of U.S, medical students; effects of Medicare an d Medicaid; changes in immigration and naturalization laws that increa sed the number of international medical graduates (IMGs); the medical community's non-response to the 1981 GMENAC Report's forecasts on phys ician oversupply; growth in the numbers of specialists; the fall and-s ubsequent rise in the numbers of-applicants to medical schools; the ch anging composition of the physician workforce; the refusal of the medi cal profession to consider a shorter training period for physicians; a nd other events from the past that can inform. today's policymakers. T he author then evaluates four policy recommendations that have evolved to deal with the problem of physician oversupply, and concludes that (1) reliance on the market to contain physician supply is unwarranted; (2) there is little prospect that Congress will soon reduce the inflo w of IMGs, and even if it did, such action would have a marginal effec t; (3) there is no prospect that 20-25% of U.S. medical schools will b e closed by 2005, since the forces militating against such action are overwhelming; and (4) it remains to be seen whether the new health car e environment will have more than a marginal effect in altering the cu rrent ratio of primary care to specialist physicians in the years ahea d, In fact, if future outlays for health care increase as predicted, t here should he sufficient funds for physician supply to continue to gr ow and for specialists to continue to make good incomes.