The Nation's Physician Workforce: Options for Balancing Supply and Requirements -- Copyright -- Preface -- Acknowledgments -- Contents -- The Nation's Physician Workforce: Options for Balancing Supply and Requirements -- Summary -- U.S. PHYSICIAN SUPPLY AND REQUIREMENTS -- RELATIONSHIP OF PHYSICIAN SUPPLY TO KEY ELEMENTS OF THE HEALTH CARE SYSTEM -- STRATEGIES FOR ADDRESSING PHYSICIAN SUPPLY ISSUES -- Producing Physicians from U.S. Medical Schools -- Revamping Graduate Medical Training -- Controlling IMG Numbers through GME -- Replacement Funding for IMG-Dependent Hospitals -- Data Collection and Information Dissemination -- CONCLUDING STATEMENT -- 1 Introduction -- THE PHYSICIAN WORKFORCE -- THE MATCH-OR MISMATCH-BETWEEN SUPPLY AND REQUIREMENTS -- ORIGINS AND ORGANIZATION OF THE STUDY -- Charge to the Committee and Project Activities -- Related Issues -- Principles Underlying Committee Conclusions and Recommendations -- ORGANIZATION OF THIS REPORT -- 2 U.S. Physician Supply and Requirements: Match or Mismatch? -- PHYSICIAN WORKFORCE ISSUES SINCE WORLD WAR II -- General Issues -- Pre-1980s Era -- Current Status -- Physician Workforce Trends -- Overall Trends in Supply -- Trends in Graduate Medical Education -- METHODS OF ESTIMATING PHYSICIAN SUPPLY, PRODUCTIVITY, AND REQUIREMENTS -- Physician Supply -- Physician Productivity -- Physician Requirements -- THE FUTURE REQUIREMENT FOR PHYSICIANS -- Factors That Could Increase Requirements -- Factors That Could Decrease Requirements -- Managed Care -- Use of Nonphysician Personnel -- INTERNATIONAL COMPARISONS -- MATCH OR MISMATCH? -- Conclusions of Physician Workforce Studies -- Evidence from the Marketplace -- Physician Incomes -- Other Evidence -- CONCLUSION -- NOTES -- APPENDIX -- A Brief Note on Managed Care -- 3 Relationship of Physician Supply to Key Elements of the Health Care System.

HEALTH CARE EXPENDITURES -- Competition -- Physician Incomes -- Health Care Costs -- ACCESS TO CARE -- Geographic Distribution -- Specialty Distribution -- Summary Comment About Access to Care -- QUALITY OF CARE -- High Numbers of Physicians Overall -- General Effects -- Volume and Quality -- Provider and Consumer Satisfaction -- Specialist-Generalist Issues -- Education and Training -- Issues Relating to IMGs -- Costs, Quality, and Physician Supply -- Summary Comment -- OTHER ISSUES IN PRODUCTION AND UTILIZATION OF THE PHYSICIAN WORKFORCE -- Human Resources Considerations -- Opportunities for Medical Careers -- U.S. Policy and the World Output of Physicians -- Future of Academic Health Centers -- General Issues -- The Service-Training Link and IMG-Dependent Institutions -- CONCLUSION -- NOTES -- 4 Strategies for Addressing Physician Supply Issues -- DO NOTHING: THE FREE OR UNREGULATED MARKET APPROACH -- INSTITUTE CENTRAL FEDERAL REGULATION -- General Approaches to Planning and Managing Physician Supply -- Committee Views -- A CONSTRAINED MARKET APPROACH -- Antitrust Considerations -- Production of Physicians from U.S. Medical Schools -- Revamp Graduate Medical Training -- Reduce GME Positions Without Changing GME Funding -- Reduce First-Year Residency Positions and Change The Approach to GME Funding -- Disconnect Funding of Service Delivery From Physician Training -- Specific Controls on Immigration -- Central Government Regulation -- Controlling IMG Numbers Through GME -- Replacement Funding for IMG-Dependent Hospitals -- Data Collection and Information Dissemination -- CONCLUDING STATEMENT -- NOTES -- References -- APPENDIX Biographies of Committee Members.