M E Whitcomb1. 1. Association of American Medical Colleges, Washington, DC 20037-1126, USA.
Abstract
OBJECTIVE: To assess the adequacy of the US generalist physician workforce using population-based, cross-national physician workforce data. DESIGN: A comparative analysis of physician workforce data obtained from primary sources in Canada in 1991 and from England and Germany in 1993. METHODS: Generalist physician-to-population ratios were calculated for each country and the results compared in the context of how primary care services are delivered. The findings were used to create a framework for analyzing the adequacy of the generalist physician workforce of the United States. MAIN OUTCOME MEASURE: The comparability of the number of primary care providers per 100 000 population in the US physician workforce with the number in Canada, England, and Germany. RESULTS: On a population basis, the size of the full-time US generalist physician workforce is larger than that of England, similar to that of Germany, and smaller than that of Canada. These size differences are largely reconciled when one takes into account differences in the way primary care services are delivered, the degree to which nurse practitioners are employed in each country, and the degree to which nongeneralist physicians provide primary care services. CONCLUSIONS: The size of the US generalist physician workforce is currently adequate to meet the needs of the population. Policies designed to greatly expand the size of the US generalist physician workforce are ill-conceived.
OBJECTIVE: To assess the adequacy of the US generalist physician workforce using population-based, cross-national physician workforce data. DESIGN: A comparative analysis of physician workforce data obtained from primary sources in Canada in 1991 and from England and Germany in 1993. METHODS: Generalist physician-to-population ratios were calculated for each country and the results compared in the context of how primary care services are delivered. The findings were used to create a framework for analyzing the adequacy of the generalist physician workforce of the United States. MAIN OUTCOME MEASURE: The comparability of the number of primary care providers per 100 000 population in the US physician workforce with the number in Canada, England, and Germany. RESULTS: On a population basis, the size of the full-time US generalist physician workforce is larger than that of England, similar to that of Germany, and smaller than that of Canada. These size differences are largely reconciled when one takes into account differences in the way primary care services are delivered, the degree to which nurse practitioners are employed in each country, and the degree to which nongeneralist physicians provide primary care services. CONCLUSIONS: The size of the US generalist physician workforce is currently adequate to meet the needs of the population. Policies designed to greatly expand the size of the US generalist physician workforce are ill-conceived.