Thereʼs a Shortage of Specialists

Abstract

The author critiques the long-standing belief that there will be too many physicians, particularly specialists, a view put forth by the Bureau of Health Professions and the Council on Graduate Medical Education in the 1990s and held by many medical organizations, including the Association of American Medical Colleges. He cites his own research, which predicts, to the contrary, that the United States will experience progressively more severe shortages of specialists, and he quotes a wide variety of anecdotal evidence indicating that such shortages are beginning to appear already. He maintains that most previous workforce studies were handicapped by their use of micro-quantitative models. Instead, his research has been structured around four broad trends: economic expansion (which directly influences the demand for physicians), physician work-effort (which is declining), the provision of physicians' services by non-physician clinicians (which is increasing), and the growth of the U.S. population (which often has not been factored in adequately). It is the intertwining of these four major trends that reveals the impending shortages of physicians. He recommends that attention be directed to training more specialists, but cautions against a further dependence on international medical graduates to fill the gap. Instead, he calls upon academic medicine to expand the infrastructure for medical education. However, despite what he sees as a growing cacophony of voices expressing alarm about the developing shortages, he is concerned that academic medicine may not be listening.