Health manpower: numbers, distribution, quality.

Although the "health care crisis" was thought solvable by simply increasing the number of physicians, this has turned out not to be the case. The major problems in physician manpower are geographic maldistribution with a sparsity of physicians in the rural areas and the inner city and an overproduction of specialists. Certain changes in undergraduate and postgraduate medical education have contributed to this maldistribution. There is good evidence that there is an overproduction of surgeons and of medical subspecialists such as cardiologists. Much of the excess subspecialization can be laid at the foot of graduate training programs. The role of the specialty boards in affecting career choices and with them health manpower is analyzed. Some solutions to solve the geographic and specialty maldistribution problems are suggested. It is clear that more primary care physicians including general internists, family physicians, and pediatricians are needed.