Medical Professionals - Doctors Are Specialists

"In 1965 there were 115 practicing physicians (excluding physicians in training) for every 100,000 people. By the late 1990s there were almost 200 per 100,000, an increase of nearly 75 percent even after accounting for the underlying growth in the U.S. population. The increase in physician supply per capita occurred almost exclusively for specialists." — Kevin Grumbach

It's true that there was substantial growth in medical, surgical, and other specialties from 1970 to 1996 (chart). Medical specialties went from 9.3 to 32.6 per 100,000 population (up 250%). Surgical specialties went from 41.4 to 55.6 (up 34%). "Other" specialties went from 43.3 to 70.3 (up 62%).⁷ There was also substantial growth in the number of primary care physicians (general and family practice, internal medicine, and pediatrics), from a ratio of 55.7 to 80.2 per 100,000 population (up 44%).

Primary Care Physicians and Selected Specialists Per 100,000 Population

	1970	1980	1985	1991	1996
Primary Care	55.7	63.2	70.5	77.1	80.2
Medical Specialties
Cardiovascular Disease	3.1	4.2	5.5	6.4	7.1
Surgical Specialties
General Surgery	14.3	14.7	15.8	15.3	14.1
Obstetrics and Gynecology	9.1	11.4	12.8	13.7	14.2
Ophthalmology	4.8	5.6	6.1	6.4	6.6
Orthopedic Surgery	4.6	6.1	7.1	8.0	8.3
Other Specialties
Anesthesiology	5.2	6.9	9.1	11.0	12.4
Diagnostic Radiology	0.9	3.0	5.3	6.7	7.4
Emergency Medicine	0.0	2.5	4.7	6.0	7.4
Pathology and Forensic Pathology	5.0	5.9	6.5	6.8	6.8
Psychiatry	10.2	11.9	13.3	14.2	14.2

The table shows data on the subspecialties in which the greatest number of physicians are now concentrated. What brought about this tremendous rise in the number of medical specialists? The development of modern medical techniques demanded more specialists. For example, the table shows a growth rate in anesthesiology specialists of 138%, from 5.2 per 100,000 population in 1970, to 12.4 in 1996.

Other factors contributed to a rise in specialists, including Medicare legislation of the 1960s, which focused national attention on a growing elderly population. The consensus was that there was an inadequate supply of physicians to meet their needs. According to Dr. Sidney Weissman: "The federal government intervened to increase physician supply and supported an increase in the number and size of medical schools. From the early 1960s to 1975, the number of U.S. medical school graduates rose from 8,000 to 16,000 per year." The number of geriatricians or physicians with any type of geriatric training has not grown, however, a phenomenon the Alliance for Aging Research (AAR) attributes to a lack of national resolve and age denial ("Peter Pan medicine"). According to AAR, only about 9,000 of America's 701,000+ practicing physicians are certified with added qualifications in geriatrics.

According to Grumbach, 1963 to 1990 was "the epoch of government blank checks…. Open-ended federal subsidies to teaching hospitals provided financial incentives for more specialized physician training programs. By the 1990s the federal government was spending more than $6 billion per year for graduate medical education (GME), with state governments contributing additional funds." The next thing we knew, we had too many specialists. Or did we? The next panel looks at this and other current concerns about the physician supply.

Sources: Chart: Bureau of Health Professions, United States Health Workforce Personnel Factbook, Table 202, http://bhpr.hrsa.gov/healthworkforce/factbook.htm; Primary sources: American Medical Association. Physician Characteristics and Distribution in the US 1997/98, Chicago, 1997. Also prior annual issues (formerly titled Physician Distribution and Medical Licensure in the U.S.) and U.S. Bureau of the Census. Current Population Reports. Series P-25 Nos. 941, 943, 1023, 1036, 1049, 1075, and 1093, Statistical Abstract of the United States: 1997 (117th edition) Washington, DC, 1997. AHRQ Focus on Research, "Rural Health Care," http://www.ahcpr.gov/news/focus/focrural.htm. U.S. General Accounting Office, Health Workforce: Ensuring Adequate Supply and Distribution Remains Challenging, August 1, 2001, http://www.gao.gov/. Kevin Grumbach, "Fighting Hand To Hand Over Physician Workforce Policy," September/October 2002, http://www.healthaffairs.org/freecontent/v21n5/s6.htm. Sidney Weissman, M.D., "Psychiatrists: Shortage or Surplus?" Psychiatric Times, October 1997, vol XIV, Issue 10, http://www.psychiatrictimes.com. Mike Mitka, As Americans Age, Geriatricians Go Missing," JAMA Medical News & Perspectives, http://jama.ama-assn.org. Information retrieved September 30, 2002.