Executive Summary

December 2008

Executive Summary

An adequate supply of physicians is needed to help ensure access to affordable, quality health care.  For the past 2 decades the number of graduates from the Nation’s medical schools has been relatively constant, following rapid growth in physician supply during the 1970s.  The physician workforce is aging, average hours worked are falling compared to historical levels, and a large number of physicians are nearing retirement.   After nearly 3 decades of growth, the physician-to-population ratio is leveling off and is expected to decline.  At the same time, the growth and aging of the United States population, as well as advances in technology with an accompanying growth in public expectations, contribute to a growing demand for physician services.

To help meet its mission to provide health workforce information, HRSA has supported research on physician workforce issues and maintains the Physician Supply Model and Physician Requirements Model.  This report describes the various components of these models and presents projections of the supply of and demand for physicians under alternative scenarios reflecting different assumptions about the future health care system, the evolving role of physicians, and trends in other supply and demand determinants.

The baseline projections assume that over the next 1 to 2 decades factors affecting physician supply, health care utilization patterns, and health care delivery patterns will continue largely unchanged.  These baseline projections suggest:

• Physician supply will increase from current levels of approximately 817,000 active physicians under age 75 in 2005 to approximately 952,000 active physicians by 2020.
• The increasing proportion of physicians who are women and are older, and who typically work fewer hours per year compared to their  younger male colleagues, suggests that total hours of physician services provided is increasing less rapidly than the number of licensed physicians (13 percent versus 16 percent between 2005 and 2020).
• The growth and aging of the population will contribute to a 22 percent increase in demand for physician services between 2005 and 2020.  Growth in demand will be highest among specialties that predominantly serve the elderly (e.g., cardiology, internal medicine, and most surgical specialties).
• Growing public expectations and the ability to pay for higher levels of care through economic growth could increase demand substantially above the baseline projections.  Factors that may offset the growth in demand for physicians include improvements in physician productivity such that each physician can care for a larger population, scientific advances that can contribute to improved health, and increased use of non-physician clinicians.

The Federal Government, as a major player in the health care system via its role as health care insurer, a subsidizer of physician training, and through its mission to improve access to care to underserved populations, has often helped to improve access to affordable, quality health care.

The modest but growing projected shortfall of physicians could contribute to greater geographic disparities in physician supply.  For several decades the United States has been a net importer of medical school graduates.  A growing demand for physicians that exceeds production from U.S. medical schools could make the Nation even more reliant on international medical schools, at a time when other nations face greater health workforce inadequacies than our own.

The health care system continues to evolve as does the role of physicians.  Because of the long length of time needed to train physicians and to change our education infrastructure, policymakers, educators, physicians, and other stakeholders need to know at least a decade in advance how changes in the health care system and other trends will affect the adequacy of physician supply.  Updating physician supply and demand projections every few years would allow the Federal Government to better reflect the latest trends and to provide advance warning of changes in the adequacy of physician supply.

Finally, it should be noted that the physician workforce is only one part of an increasingly complex health care system in which the final goal is a healthier society.  The link between number and type of physicians, as well as the content of their education, and the health status of the populations they serve has yet to be completely understood.  Further investigation regarding the impact of the physician workforce on health will better inform workforce planning.

Key Acronyms