Physician Surplus or Shortage? How reliable are the studies of projected need of physicians? How reliable are the studies of projected costs?

Studies can never provide an accurate assessment of future physician demand.  Some studies, in fact, have missed the boat completely.  Edward J. Miller, Ph.D., a Political Science professor at University of Wisconsin-Stevens Point, outlined a number of such studies in his paper, “The Physician Workforce Shortage and the Implications for Expanded Medical Coverage.”[1] Among Miller’s findings:

• “The Council on Graduate Medical Education (COGME) in 1991 predicted a surplus of 80,000 physicians by 2000 and recommended limiting the number of residencies to 10% above the number of U.S. medical graduates.”
• “To reduce the number of physicians trained, the federal government included in the Balanced Budget Act of 1997 an incentive for hospitals to reduce the number of residency slots available.”

Some researchers disagreed that a physician surplus in the making.  In fact, they argued the opposite.    

• “Richard Cooper and colleagues challenged the potential glut conclusion, arguing that the U.S. will experience a shortage of around 200,000 physicians between 2020 and 2025 (Cooper, et al., 2002).”

§         “The COGME projects a shortfall, but about 85,000 nationally, less than half of what Cooper forecasted (Wilson, 2005, pp. 469-470; Association of American Medical Colleges, 2006a).”

A Physician Workforce Shortage Loomed Even Before the Passage of Health Care Reform.

• “An analysis of the projected supply and demand for physicians, conducted by the Health Resources and Services Administration in 2008, foretells of a total shortage across the entire workforce. Particularly evident is the deficit projected in non-primary care subspecialties, with a shortage of 35,000 surgeons and 27,000 medical specialists by 2020.”[2]
• “Even five years from now – in 2015 – there will be a deficit of 62,900 physicians. Looking out further – to 15 years from now, in 2025 – that shortage is likely to have doubled, with a projected deficit of more than 130,000 physicians across all specialties.”[3]

The Congressional Budget Office’s estimates regarding specific legislative proposals have sometimes been too low (like Medicare, and the recent health care law):

• “In 1965, the
  House Ways
  and Means Committee estimated that the hospital insurance program of Medicare - the federal health care program for the elderly and disabled - would cost $9 billion by 1990. The actual cost that year was $67 billion.”[4]

§         “In 1987, Congress projected that Medicaid - the joint federal-state health care program for the poor - would make special relief payments to hospitals of less than $1 billion in 1992. Actual cost: $17 billion.”[5]

In conclusion, studies are important to provide guidance in setting up public policies; but the projected needs or costs are usually wrong. For instance, Texas’ budget shortfall was estimated to be $11 billion in early 2010 and was recently forecast to be as high as $25 billion. The actual amount is $27 billion, just released yesterday by the Texas Comptroller.

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[1] Miller, Edward J.  “The Physician Workforce Shortage and the Implications for Expanded Medical Coverage.”  Accessed December 26, 2010.  URL: http://www.uwsp.edu/business/cwerb/SR%20PDFs/The%20Physician%20Workforce%20Shortage%20and%20The%20Implications%20for%20Expanded%20Medical%20Coverage.pdf.

[2] American Association of Medical Colleges (AAMC).  “Physician Shortages to Worsen Without Increases in Residency Training.”  Accessed December 26, 2010.  URL: https://www.aamc.org/download/150584/data/physician_shortages_to_worsen_without_increases_in_residency_tr.pdf.

[3] Ibid.

[4] “U.S. health plans have history of cost overruns.”  The Washington Times, November 28, 2009.  Accessed December 28, 2010.  URL: http://www.washingtontimes.com/news/2009/nov/18/health-programs-have-history-of-cost-overruns.

[5] Ibid.