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Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
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OCR for page 10
10
THE EXTENT OF THE PHYSICIAN SHORTAGE
in 1972 the National Institute for Occupational Safety
and Health (NtOSH) identified a shortage of 3,000
physicians in occupational medicine and a projected
national need for 5,400 such specialists.72 In 1980 the
Graduate Medical Education National Advisory Committee
(GMENAC) estimated the need by 1990 for 2,300
board-certified occupational medicine specialists,~3 a
smaller number from that initially estimated by a technical
pane' convened by GMENAC. The lowered projection
reflected both limitations in availability of medical training
and a perception by some that physicians in preventive
medicine made lithe contribution to clinical services.73~4 A
1988 report by the Bureau of Health Professions (BHPr) of
the Health Resources and Services Administration
estimated the need in 1992 for 4,830 board-certified
specialists, the first estimate to include the need for
environmental as well as occupational medicine
specia~ists.75
OCR for page 11
11
The lOM Subcommittee on the Physician Shortage
commissioned a needs estimate that included fully trained
OEM specialists as well as OEM clinicians, the lager defined
as primary care physicians with added competence in the
field, who would serve as consultants and educators when
specialists were not needed or accessible. The resulting
estimate of 1989 need by Castorina was 3,100 to 4,700
full-fledged specialists and 1,500 to 2,000 GEM
clinicians. The estimate of specialists was based on a
need for (1) 127 to 378 academic faculty (1 to 3 faculty
per 127 medical schools); (2) 2,400 to 3,600 community
specialists (1.0 to 1.5 specialists per 100,000 population);
and (3) 550 to 700 physicians in public health agencies (1
physician per 505 local programs serving 100,000
inhabitants and 1-3 per 57 state and territorial health
agencies). The need for 1,500 to 2,000 OEM clinicians
was taken as 0.75 percent to 1 percent of all primary care
physicians (195,538 internists, family practitioners, general
practitioners and pediatricians) se~f-identified in the
American Medical Association postal survey in 1987. ]7
Estimates of physician supply in this field have been
largely derived from some form of self-report or
se~f-designation on the part of the physician. None has
deliberately included the relatively new and less defined
field of environmental medicine. GMENAC projections
overall for the 1990 supply of preventive medicine
specialists, adjusted to the proportion of AMA survey
respondents who practice occupational medicine (40
percent), yield an estimate of 2,200 trained specialists.
Other estimates of supply include (1) AMA self-report,
2,700; (2) American College of Occupational Medicine
membership, 4,800; and (3) Bureau of Health Professions
(using board-certification figures for 1987 extrapolated to
OCR for page 12
12
1992), 1,550. Based on available data about the number
of individuals board-certified to date (1,378) and
preliminary data that about 15 percent are no longer
active, Castorina estimated for 1989 a supply of between
1,200 and 1,500 active, board-certified or board-eligible
occupational medicine specialists.
Table ~ reviews the range of estimates of the
physician shortage in occupational medicine. Although the
final GMENAC estimates identify only a small deficit (10
percent), the GMENAC preventive medicine specialty
(Delphi) pane! estimatecl a deficit of more than 2,000,
closer to the BHPr estimate of a shortage of more than
3,000. Because of the limitations of these estimates,
including the lack of specific consideration of
environmental medicine as part of the field, Castorina
estimated a current shortage of 3,100 to 5,500 physicians,
numbers that include primary care physicians with special
competence in occupational and environmental medicine
(OEM clinicians). For OEM specialists only, the deficit
would range between 1,600 and 3,500.
OCR for page 13
13
Table 1. The Physician Shortage in Occupational and
Environmental Medicine
Source
Estimate Need Supply
for Year (estimated number) Deficit
GMENAC1 1990 2,000a 2,200a 1 OOa
BHPr2 1992 4,830a 1,550a 3,280a
Castorina
and Rosenstock3 1989 4,600-6,700b 1,200-1,500a 3,100-5,500b
a Estimate for occupational medicine specialists only.
b Estimates for specialists and IOM clinicians (physicians with special
competence in occupational and environmental medicine).
1 Graduate Medical Education National Advisory Committee; see reference 15.
2 Bureau of Health Professions; see reference 17
3 See reference 1.
Representative terms from entire chapter:
physician shortage
