REPLY
Subspecialty Work Force Issues
Lewis G. Sandy and
Steven A. Schroeder
15 May 1995 | Volume 122 Issue 10 | Page 804
IN RESPONSE:
We applaud the Association of Subspecialty Professors' continued commitment to addressing subspecialty work force issues. The Association continues to voice skepticism over existing work force projections and prefers need-based modeling. However, decades of research have been devoted to the study of physician-induced demand [1, 2], highlighting the instability of population "need." Moreover, the number of physicians required for any population's "need" is sensitive to population and organizational factors, such as service regionalization.
Although we agree with the Association that the United States is headed towards an excess of physicians in aggregate, existing projections estimate that the bulk of that excess lies in the specialty domain [3]. We grant that this varies across the subspecialties and is most concentrated in the procedure-oriented medical subspecialties.
Without national health care reform, two choices remain—laissez faire, market-directed work force reactivity that would be a disservice to both patients and the profession, or proactive, concerted action by medical leadership across the board to solve this important national problem [4].
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Author and Article Information
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For the Association of Subspecialty Professors, Philadelphia, PA 19104. The Robert Wood Johnson Foundation, Princeton, NJ 08543-2316.
1. Menken M. Consequences of an oversupply of medical specialists: the case of neurology. N Engl J Med. 1983; 308:1224-6.
2. Reinhardt UE. Health manpower forecasting: the case of physician supply. In: Ginsberg E, ed. Health Services Research: Key to Health Policy. 1991; 278-80.
3. Weiner JP. Forecasting the effects of health reform on U.S. physician workforce requirement: evidence from HMO staffing patterns. JAMA. 1994; 272:220-30.
4. Cohen JJ. From the president: time to stanch the flow of residents. Acad Med. 1994; 69:464-5.
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