into account the full range of practitioners (not just physicians) who will be delivering services to patients in the next century.
In rebuttal, Tarlov (1995) notes the near unanimity of projections of substantial physician surpluses in analyses since 1980 and draws attention to the considerable uncertainties that surround the Cooper assumptions. Tarlov also calls for more creative actions on the part of many parties to deal not only with workforce supply issues but also to achieve other health goals as well, including reducing the disparities in access for underserved populations and increasing the representation of minorities in the medical profession. The most recent publication of the Pew Health Professions Commission comes down forcefully on the side of surplus, using language such as "a large oversupply" that will result in a "dislocation of crisis proportions" (Pew Health Professions Commission, 1995, p. 42). By and large, the IOM committee reporting here subscribes to the majority view; namely, that the nation does face a meaningful oversupply of physicians, in the aggregate, in coming years.
Figure 6-1 provides some basic data on the growth in physicians in this country over the past nearly 50 years. According to federal statistics, the number of active nonfederal M.D. physicians per 100,000 population in 1950, for example, was 126.6; the figure rose to 127.4 in 1960 and 137.4 in 1970 (DHHS, 1993). In effect, for 35 years or so since the end of World War II, the nation believed it had a considerable shortage of physicians. Steps were taken in the 1960s and 1970s both to expand the production of physicians within the country and to liberalize the rules by which foreign (now international) medical graduates could enter the United States for training and remain to practice.
The change in U.S. physician supply was dramatic.2 Between 1970–1971 and 1991–1992 the annual number of medical school graduates increased from approximately 9,000 to more than 15,000 (for allopathic schools, or M.D.s) and from 500 to more than 1,500 (for osteopathic schools, or D.O.s). As a result of these increases and federal policies that allowed more IMGs to practice in the United States, the number of physicians per 100,000 population increased dramatically between 1970 and 1990.
Active physicians numbered 151.4 per 100,000 population in 1970 and 267.5 per 100,000 in 1992 (IOM, 1996a). Put another way, the nation had 1 active physician for every 584 persons in the country in the mid-1970s (DHEW, 1977) and 1 for every 398 persons by the early 1990s. For active nonfederal M.D.s, the physician-to-population figures were 137.4 M.D.s per 100,000 population in 1970 and 219.5 in 1991, a rise of 60 percent. The percentage increase in the ratio of active nonfederal D.O.s was 104 percent (on a considerably smaller base), from 5.7 D.O.s per 100,000 persons in 1970 to 11.6 in 1991.