Renewed debate: Is there a physician shortage?

By 2010, the United States will experience a shortage of 50,000 physicians, rising to 200,000 physicians by 2020, according to an analysis published in the January/February 2002 Health Affairs. Based on historical links between growth of gross domestic product and growth of physician supply, the authors estimate that the demand for physician services will increase 1.1 percent to 1.5 percent annually, a rate that current physician training levels cannot meet.

While this may sound like good news – and future job security – for family physicians, it isn’t. The authors argue that demand will be greatest for “medical and surgical specialists.” They cite 1995 data suggesting that as personal income increases, the supply of family physicians and general practitioners actually decreases, while the supply of medical and surgical specialists increases.

But the authors’ hypothesis is not without controversy. Kevin Grumbach, MD, who wrote one of seven analyses published with the study, argued that this relationship between economic growth and physician supply is simply a description of past trends and is not a rule for projecting future demand or for determining proper demand. He made the analogy that specialists are like “gas-guzzling” sport utility vehicles (SUVs): They may be in high demand, but they aren’t the wisest purchase option when you consider the social costs. The “SUV-ification of U.S. health care,” according to Grumbach, would result in “a system built out of proportion to the true needs of the public for efficient and effective health care.” He cited several studies that suggest a greater supply of specialists is not associated with better health in a population.

Severe vaccine shortage results in rationing

High demand and production difficulties at several U.S. vaccine manufacturers have caused severe shortages of vaccines for eight of the 11 vaccine-preventable diseases and “the worst crisis” in the National Immunization Program’s 29-year history, according to the Feb. 11 Wall Street Journal. In response, the Centers for Disease Control (CDC) has begun rationing supplies of tetanus and diphtheria vaccines, limiting them to hospitals, emergency rooms and public health departments, and eliminating booster shots. Scheduled vaccinations for whooping cough, pneumoccocal disease and chicken pox have also been delayed for many patients.

In January, the AAFP, the CDC and the American Academy of Pediatrics released the 2002 Childhood Immunization Schedule, which includes prioritization recommendations for the use vaccines that are in short supply. For more information, go to www.aafp.org/exam/rep-520.html.

“If this [shortage] continues much longer or worsens, we will have a major health crisis,” says Adm. Walter Orenstein, chief of immunizations at the CDC.

Why patients leave

The primary reason patients change doctors is a lack of trust caused by doctors not spending enough time listening to patients, not involving them in decisions or not answering their questions sufficiently, according to a study published in the January 2002 Journal of General Internal Medicine. Seventy-eight percent of the 2,052 patients studied reported a physician-communication problem leading to lower levels of trust.

Updating the Hippocratic oath

To help physicians meet the needs of patients in the 21st century and renew their sense of professionalism, three medical organizations have joined together to write a new professional code of conduct, an update of the 2,500-year-old Hippocratic oath. Their charter, published in the Feb. 5 Annals of Internal Medicine and the Feb.9 The Lancet, includes three fundamental principles physicians should follow (primacy of patients’ welfare, patient autonomy and social justice) and 10 professional responsibilities, including a commitment to improve patients’ access to care and a commitment to maintain trust by managing conflicts of interest.

Waived test list available online

Of the 88 percent of AAFP members who perform lab tests in their office, about half do waived testing, according to an AAFP survey. Three years ago, about 30 percent performed waived testing. The surge in waived testing is most likely due to the increasing number of tests receiving CLIA-waived status, such as test kits for Strep antigen, infectious mononucleosis, protime, H. pylori, hemoglobin A_1C and influenza. To see a current list of waived tests visit www.aafp.org/pt/clia/index.html and click on CLIA waived and PPM tests.

Get ready to haggle

In the past year, 17 percent of health care consumers asked for a discount on a medical bill, and almost half say they succeeded, according to a recent Harris poll quoted in the Feb. 8 Wall Street Journal. The article reported that the use of professional hagglers increased 20 percent last year and is expected to grow as employers move away from traditional insurance and give individuals more control of their health care dollars.