numbers must be made in the context of the overall U.S. health care system and the components of that system that are of greatest concern (e.g., the quality and costs of health care and access to services). It was certainly of the view that the growth in physicians training and entering practice each year is sufficient to cause concern that supply in the future will be excessive, regardless of the assumptions made about the structure of the health care system. Finally, the committee concluded that the steady rise in numbers of physicians coming into practice is attributable primarily to ever-increasing numbers of IMGs, about which it is very concerned.

Two major sets of questions remain, however. Will the current or anticipated numbers of physicians have, on balance, positive or negative consequences for costs, accessibility, and quality of health care in the nation? Will that supply have beneficial or harmful effects on such matters as the efficient use of human resources and the long-term future of the nation's academic health centers? Furthermore, will those judgments differ depending on where on a "tightly managed care" to "fully fee-for-service" spectrum the U.S. health care system settles? These topics are taken up in the next chapter.



Figures for the supply of physicians in this country can diverge dramatically, depending on whether the data refer to all physicians, all active physicians, all active nonfederal physicians, patient care physicians, or some other grouping. By most accounts, active physicians are those who are neither retired nor working fewer than 20 hours per week. Different sources will use different classifications, so comparisons across sources may be invalid or at least require further examination. The committee has tried to be explicit about the groupings used in the text and in Table 2-1.


By convention, allopathic schools are distinguished from osteopathic schools. Allopathic schools produce physicians with a "doctor of medicine" (M.D.) degree; osteopathic institutions graduate those with a "doctor of osteopathy" (D.O.) degree. The former greatly outnumber the latter, today by about 126 to 16 schools.


Reporting of the number of physicians differs somewhat across the period 1970–1992. Sources include DHEW (1977), NCHS (1983), and DHHS (1993).


Some observers (e.g., Sheldon, 1991; Jonasson et al., 1995) believe that, for some physician categories such as general surgery, the GMENAC (1981) report estimates were off the mark because it projected the training of more surgical residents than actually have been trained. COGME (1994) also comments on shortages in several specialties, including general surgery, psychiatry, preventive medicine, and geriatrics. Consequently, the question of a significant excess of surgeons (or at least general surgeons) may be more debatable than it is for certain other subspecialties. Apart from the issue of numbers, however, lies the question of whether existing methods for predicting supply or requirements are equally appropriate across all types of physician specialties (or, indeed, across all types of health care personnel).

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