DOWNSIZING THE PHYSICIAN WORKFORCE

Objective. To estimate the need for downsizing the physician workforce in a changing health care environment. Methods. First, assuming that 1993 physician-to-population ratios would be maintained, the authors d erived downsizing estimates by determining the annual growth in the su pply of specialists necessary to maintain these ratios (sum of losses from death and retirement plus increase necessary to parallel populati on growth) and compared them with an estimate of the number of new phy sicians being produced (average annual number of board certificates is sued between 1990 and 1994). Then, assuming that workforce needs would change in a system increasingly dominated by managed care, the author s estimated specialty-specific downsizing needs for a managed care-dom inated environment using data from several sources. Results. To main-r ain the 1993 199.6 active physicians per 100,000 population ratio, 14, 644 new physicians would be needed each year. Given that an average of 20,655 physicians were certified each year between 1990 and 1994, at least 6011 fewer new physicians were needed annually to maintain 1993 levels. To main-rain the 132.2 ratio of active non-primary care physic ians per 100,000 population, the system needed to produce 9698 non-pri mary care physicians per year; because an average of 14,527 new non-pr imary care physicians entered the workforce between 1990 and 1994, dow nsizing by 4829, or 33%, was needed. To maintain the 66.8 active prima ry care physicians per 100,000 population ratio, 4946 new primary care physicians were needed per year, since primary care averaged 6128 new certifications per year, a downsizing of 1182, or 20%, was indicated. Only family practice, neurosurgery, otolaryngology, and urology did n ot require downsizing. Seventeen medical and hospital-based specialtie s, including 7 of 10 internal medicine subspecialties, needed downsizi ng by at least 40%. Less downsizing in general was needed in the surgi cal specialties and in psychiatry. A managed care dominated-system wou ld call for greater downsizing in most of the non-primary care special ties. Conclusion. These data support the need for downsizing the natio n's physician supply, especially in the internal medicine subspecialti es and hospital support specialties and to a lesser extent among surge ons and primary care physicians.