Prepaid group practice staffing and U.S. physician supply: Lessons for workforce policy

Health Affairs

Volumn 23, Issue SUPPL., 2004, Pages

  Weiner, Jonathan P ^a  

^a JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CORRELATION ANALYSIS; DEMOGRAPHY; FORCE; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH CARE MANAGEMENT; HEALTH CARE ORGANIZATION; HEALTH CARE POLICY; HEALTH CARE SYSTEM; HEALTH INSURANCE; HEALTH MAINTENANCE ORGANIZATION; HEALTH SURVEY; HUMAN; INFORMATION PROCESSING; LAW; MEDICAL PRACTICE; MEDICAL SPECIALIST; PERSONNEL MANAGEMENT; PHYSICIAN; POPULATION RESEARCH; TECHNIQUE; UNITED STATES; WORK; EMPLOYMENT; GROUP PRACTICE; MEDICINE; ORGANIZATION AND MANAGEMENT; POLICY; STATISTICS;

EMPLOYMENT; GROUP PRACTICE, PREPAID; HEALTH MAINTENANCE ORGANIZATIONS; PERSONNEL STAFFING AND SCHEDULING; PHYSICIANS; PUBLIC POLICY; SPECIALTIES, MEDICAL; UNITED STATES;

EID: 1842712863     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.W4.43     Document Type: Article

References (25)

1. U.S. Congress, Office of Technology Assessment, Forecasts of Physician Supply and Requirement, Pub. no. USGPO-052-003-00746-1 (Washington: U.S. Government Printing Office, 1980); D. Steinwachs et al., "A Comparison of the Requirements for Primary Care Physicians in HMOs with Projections Made by the GMENAC," New England Journal of Medicine 314, no. 4 (1986): 217-222; T. Dial et al., "Clinical Staffing in Staff-and Group-Model HMOs," Health Affairs (Summer 1995): 169-180; D. Goodman et al., "Benchmarking the U.S. Physician Workforce: An Alternative to Needs-Based or Demand-Based Planning," Journal of the American Medical Association 276, no. 22 (1996): 1811-1844; and H.R. Mason, "Manpower Needs by Specialty," Journal of the American Medical Association 219, no. 12 (1972): 1621-1626.
2. U.S. Congress, Office of Technology Assessment, Forecasts of Physician Supply and Requirement, Pub. no. USGPO-052-003-00746-1 (Washington: U.S. Government Printing Office, 1980); D. Steinwachs et al., "A Comparison of the Requirements for Primary Care Physicians in HMOs with Projections Made by the GMENAC," New England Journal of Medicine 314, no. 4 (1986): 217-222; T. Dial et al., "Clinical Staffing in Staff-and Group-Model HMOs," Health Affairs (Summer 1995): 169-180; D. Goodman et al., "Benchmarking the U.S. Physician Workforce: An Alternative to Needs-Based or Demand-Based Planning," Journal of the American Medical Association 276, no. 22 (1996): 1811-1844; and H.R. Mason, "Manpower Needs by Specialty," Journal of the American Medical Association 219, no. 12 (1972): 1621-1626.
3. U.S. Congress, Office of Technology Assessment, Forecasts of Physician Supply and Requirement, Pub. no. USGPO-052-003-00746-1 (Washington: U.S. Government Printing Office, 1980); D. Steinwachs et al., "A Comparison of the Requirements for Primary Care Physicians in HMOs with Projections Made by the GMENAC," New England Journal of Medicine 314, no. 4 (1986): 217-222; T. Dial et al., "Clinical Staffing in Staff-and Group-Model HMOs," Health Affairs (Summer 1995): 169-180; D. Goodman et al., "Benchmarking the U.S. Physician Workforce: An Alternative to Needs-Based or Demand-Based Planning," Journal of the American Medical Association 276, no. 22 (1996): 1811-1844; and H.R. Mason, "Manpower Needs by Specialty," Journal of the American Medical Association 219, no. 12 (1972): 1621-1626.
4. U.S. Congress, Office of Technology Assessment, Forecasts of Physician Supply and Requirement, Pub. no. USGPO-052-003-00746-1 (Washington: U.S. Government Printing Office, 1980); D. Steinwachs et al., "A Comparison of the Requirements for Primary Care Physicians in HMOs with Projections Made by the GMENAC," New England Journal of Medicine 314, no. 4 (1986): 217-222; T. Dial et al., "Clinical Staffing in Staff-and Group-Model HMOs," Health Affairs (Summer 1995): 169-180; D. Goodman et al., "Benchmarking the U.S. Physician Workforce: An Alternative to Needs-Based or Demand-Based Planning," Journal of the American Medical Association 276, no. 22 (1996): 1811-1844; and H.R. Mason, "Manpower Needs by Specialty," Journal of the American Medical Association 219, no. 12 (1972): 1621-1626.
5. U.S. Congress, Office of Technology Assessment, Forecasts of Physician Supply and Requirement, Pub. no. USGPO-052-003-00746-1 (Washington: U.S. Government Printing Office, 1980); D. Steinwachs et al., "A Comparison of the Requirements for Primary Care Physicians in HMOs with Projections Made by the GMENAC," New England Journal of Medicine 314, no. 4 (1986): 217-222; T. Dial et al., "Clinical Staffing in Staff-and Group-Model HMOs," Health Affairs (Summer 1995): 169-180; D. Goodman et al., "Benchmarking the U.S. Physician Workforce: An Alternative to Needs-Based or Demand-Based Planning," Journal of the American Medical Association 276, no. 22 (1996): 1811-1844; and H.R. Mason, "Manpower Needs by Specialty," Journal of the American Medical Association 219, no. 12 (1972): 1621-1626.
6. R. Kronick et al., "The Marketplace in Health Care Reform: The Demographic Limitations of Managed Competition," New England Journal of Medicine 328, no. 12 (1993): 148-152; J. Weiner, "Forecasting the Effects of Health Reform on U.S. Physician Workforce Requirement: Evidence from HMO Staffing Patterns," Journal of the American Medical Association 272, no. 3 (1994): 222-230; and A. Tarlov, "HMO Growth and Physicians: The Third Compartment," Health Affairs (Spring 1986): 23-35.
7. R. Kronick et al., "The Marketplace in Health Care Reform: The Demographic Limitations of Managed Competition," New England Journal of Medicine 328, no. 12 (1993): 148-152; J. Weiner, "Forecasting the Effects of Health Reform on U.S. Physician Workforce Requirement: Evidence from HMO Staffing Patterns," Journal of the American Medical Association 272, no. 3 (1994): 222-230; and A. Tarlov, "HMO Growth and Physicians: The Third Compartment," Health Affairs (Spring 1986): 23-35.
8. R. Kronick et al., "The Marketplace in Health Care Reform: The Demographic Limitations of Managed Competition," New England Journal of Medicine 328, no. 12 (1993): 148-152; J. Weiner, "Forecasting the Effects of Health Reform on U.S. Physician Workforce Requirement: Evidence from HMO Staffing Patterns," Journal of the American Medical Association 272, no. 3 (1994): 222-230; and A. Tarlov, "HMO Growth and Physicians: The Third Compartment," Health Affairs (Spring 1986): 23-35.
9. An expanded Exhibit 2, with the specialty-specific physician staffing rates for each of the six Kaiser Permanente regions, is available online at content.healthaffairs.org/cgi/content/full/hlthaff.w4.43vl/DC2.
10. Weiner, "Forecasting the Effects"; J. Weiner, C. McLaughlin, and S. Gamliel, "Extrapolating HMO Staffing to the Population at Large," in The U.S. Health Workforce: Power, Politics and Policy, ed. M. Osterweis et al. (Washington: Association of Academic Health Centers, 1996), 311-326; and L.G. Hart et al., "Physician Staffing Ratios in Staff-Model HMOs: A Cautionary Tale," Health Affairs (Jan/Feb 1997): 55-70.
11. Weiner, "Forecasting the Effects"; J. Weiner, C. McLaughlin, and S. Gamliel, "Extrapolating HMO Staffing to the Population at Large," in The U.S. Health Workforce: Power, Politics and Policy, ed. M. Osterweis et al. (Washington: Association of Academic Health Centers, 1996), 311-326; and L.G. Hart et al., "Physician Staffing Ratios in Staff-Model HMOs: A Cautionary Tale," Health Affairs (Jan/Feb 1997): 55-70.
12. Weiner, "Forecasting the Effects"; J. Weiner, C. McLaughlin, and S. Gamliel, "Extrapolating HMO Staffing to the Population at Large," in The U.S. Health Workforce: Power, Politics and Policy, ed. M. Osterweis et al. (Washington: Association of Academic Health Centers, 1996), 311-326; and L.G. Hart et al., "Physician Staffing Ratios in Staff-Model HMOs: A Cautionary Tale," Health Affairs (Jan/Feb 1997): 55-70.
13. Weiner et al., "Extrapolating HMO Staffing to the Population at Large." This methodology helped to account for potential differences across the two populations within the 65-74 and 75 and older age bands. It did not account for any potential PGP/U.S. population differences in older age groups.
14. Hart et al., "Physician Staffing Ratios."
15. In the states where the three study sites are located, the rates of physicians per 100,000 population are approximately as follows: Minnesota, 232; Washington, 217; and California, 218. In the metropolitan areas where most of the plans' enrollees reside, the supply is considerably higher than these state-level rates.
16. Weiner, "Forecasting the Effects."
17. E. Schaefer and J. Reschovsky, "Are HMO Enrollees Healthier than Others? Results from the Community Tracking Study," Health Affairs (May/June 2002): 249-259; and F. Hellinger and H. Wong, "Selection Bias in HMOs: A Review of the Evidence," Medical Care Research and Review 57, no. 4 (2000): 405-439.
18. E. Schaefer and J. Reschovsky, "Are HMO Enrollees Healthier than Others? Results from the Community Tracking Study," Health Affairs (May/June 2002): 249-259; and F. Hellinger and H. Wong, "Selection Bias in HMOs: A Review of the Evidence," Medical Care Research and Review 57, no. 4 (2000): 405-439.
19. J. Weiner, "The Demand for Physicians in a Changing Health Care System: A Synthesis," Medical Care Review 50, no. 4 (1993): 411-449.
20. American Medical Association, Socioeconomic Patterns of Medical Practice in the U.S., 2002/2003 (Chicago: AMA, 2002).
21. P.R. Kletke et al., "The Growing Proportion of Female Physicians: Implications for U.S. Physician Supply," American Journal of Public Health 80, no. 3 (1990): 300-303.
22. R. Feachem, N. Sekhri, and K. White, "Getting More for Their Dollar: A Comparison of the NHS with California's Kaiser Permanente," British Medical Journal 324, no. 19 (2002): 135-143.
23. R. Cooper et al., "Economic and Demographic Trends Signal an Impending Physician Shortage," Health Affairs (Jan/Feb 2002): 140-154.
24. K. Grumbach, "Fighting Hand to Hand over Physician Workforce Policy," Health Affairs (Sep/Oct 2002): 13-27; and J. Weiner, "A Shortage of Physicians or a Surplus of Assumptions?" Health Affairs (Jan/Feb 2002): 160-162.
25. K. Grumbach, "Fighting Hand to Hand over Physician Workforce Policy," Health Affairs (Sep/Oct 2002): 13-27; and J. Weiner, "A Shortage of Physicians or a Surplus of Assumptions?" Health Affairs (Jan/Feb 2002): 160-162.