Economic evidence of a primary care physician shortage

Research has suggested that in the coming years, the supply of physicians may not adequately cover patients' health care needs. Predictions of how well the future physician workforce will meet the anticipated demand of health care services can be strengthened by incorporating economic indicators of a market shortage or surplus. This study develops and fields a multi-mode survey linking physician behavior to characteristics of the physician, his/her practice and the managed care environment. Data domains include physician characteristics and income, practice revenues, hours worked, practice activities, and financial condition and structure. Multivariate weighted regression and logistic regressions were used to analyze earnings, activities, and physician perceptions about the practice pressures. Data are weighted to account for sampling design and known sources of non-response. Our study population consists of a random sample of 1200 primary care (PC) and pediatric physicians in California, Illinois, Georgia, Pennsylvania and Texas. The sample was derived from the American Medical Association Physician Masterfile. Pediatric and minority physicians were over sampled. Economic indicators evaluated in this study include market exit rates (retirement and other), specialty type switching, acceptance of new patients, physician age, practice structure changing, number of weeks worked per year, as well as wage trends, and practice earnings. If there was a pending physician shortage, economic indicators in the physician employment market would indicate higher than normal market exit rates, few physicians switching specialties or accepting new patients, a higher average physician age, static physician practice structures, physicians working near the maximum weeks per year, and rising wages and practice earnings. A pending physician surplus would drive economic indicators in the opposite direction. Preliminary results show no overall evidence of a current shortage of PC physicians. However, there is evidence of shortages in faster-growing areas and potentially a worsening shortage in already underserved communities. Earning trends, patient-care capacity, and hours worked are significant indicators of changing demands on PC physicians. Higher planned retirement rates among physicians serving minority communities suggest that these underserved areas may face growing shortages in the short-term future. The findings suggest that there may be maldistribution in PC capacity, especially in areas that are already underserved and are characterized by high numbers of minority and low-income patients. This research contributes to a better understanding of workforce policy and underscores the need to use economic incentives and develop better policy tools for assuring adequate PC capacity in currently underserved communities.