THE CHALLENGE OF DEFINING AND COUNTING GENERALIST PHYSICIANS - AN ANALYSIS OF PHYSICIAN MASTERFILE DATA

Objectives. The study reviewed methods for measuring the specialty dis tribution of the US physician workforce. It was hypothesized that curr ent databases and measurement conventions overestimate the number of g eneralist physicians. Methods. A descriptive analysis of the American Medical Association (AMA) Physician Masterfile for California was done with different assumptions about the definition of generalists based on primary and secondary specialty information. Results. A rigorous de finition of generalist physician that excludes physicians with Seconda ry practices in specialist fields resulted in an estimate of generalis t physicians 25% lower than the number estimated by conventional workf orce evaluation methods. Physicians who reported practicing in both ge neralist and specialist fields were more likely to be older, to be int ernational medical school graduates, and to be in solo or duo practice compared with physicians who listed only generalist or specialist fie lds. Conclusions. The actual number of generalist physicians in the Un ited States may be less than previously believed. Although the exact m agnitude of the ''hidden system'' of specialists providing primary car e is difficult to measure, at least a portion appear to already be cou nted as generalist physicians by current conventions.