Too many doctors or not too many doctors? Depends on who you ask

The question’s all about numbers

Talk about a topic that generates conversation around the water coolers! The talk around the hospital and medical school community has turned to employment prospects for new medical school graduates, thanks to a recent article in the Journal of the American Medical Association (JAMA).1

The JAMA article noted that about 7% of medical residents in 1996 couldn’t find a position, and more than 22% who did find a position had trouble doing so.

Although the writers noted that employment difficulties were greatest among international graduates, there was still a great disparity between what the students themselves reported as their experience and the rosy portraits painted by the reports of medical school program directors. The conclusions reached by the mainstream press have been uniform: There are too many doctors.

But other studies based on more recent data suggest not a decline in the need for physicians, but rather a shift in what practices and hospitals are seeking.

Merritt, Hawkins & Associates, a health care staffing firm based in Dallas, found that in 1997, primary care searches they conducted for practices decreased by some 17% from 1,094 in 1996 to 913 last year. That includes searches for family practitioners, general internists, and pediatricians. Specialty searches, though, increased from 570 to 797.

Phillip Miller, director of communications for the firm, says the reason for the discrepancy between the JAMA researchers’ findings and his firm’s is the age of their information. "Medicine changes on a dime," he says. "Two years ago, the accepted wisdom was that the primary care gatekeeper model would prevail. But that just isn’t so. Things change quickly, and if it was hard to find a position then, it isn’t now."

Those very changes are affecting who is being recruited, too. While it was difficult to find good primary care physicians in the past and their salaries were going up year after year, now the primary care panels are full, Miller says, and groups are looking to fill specialty voids.

Couple that with the growing clamoring for choice and patient rights, as well as a strong economy that lets people purchase more specialty care, and you see specialists are more in demand.

For the first time in a few years, says Miller, salaries for specialists are going up, while primary care physicians are seeing flat income. The two big surveys — from the American Group Medical Association of Alexandria, VA, and the Medical Group Management Association of Englewood, CO — which are due out next month will probably show the same thing, he adds.

Even if there is a recession, the trend to fill out panels with neglected specialty talent will continue, Miller says. "The era of the generalist in every profession is at an end. People want specialty talent." What could change in the future is a greater reliance on extenders like physician assistants and nurse practitioners.

JAMA had another story in the same issue on that topic.2 The authors found that non-physician clinicians — nurse practitioners and physician assistants — are becoming more prominent as health care providers. "I think that they will continue to gain ground," says Miller. "And even physician-run groups will see them as a way to curtail costs if there is a recession. They can do a lot of what primary care physicians do, but at half the cost."

Among the other findings of the Merritt, Hawkins & Associates study:

• About two thirds of the searches conducted were for group or solo practices, a number which has been fairly constant since 1996.

• Three quarters of the searches occur in communities of less than 100,000 — again a number in keeping with the past.

• Most of the packages offered were salary with production bonuses (60%).

• More practices offer signing bonuses — 29.4% compared to 26.3 percent in 1996.

For more details, contact Phillip Miller, Director of Communications, Merritt, Hawkins & Associates, Irving, TX. Telephone: (800) 876-0500.

References

1. Miller RS, Dunn MR , Richter TH, Whitcomb ME. Employment seeking experiences of resident physicians completing training during 1996. JAMA 1998; 280:777-783.

2. Cooper RA, Laud P, Dietrich CL. Current and projected workforce of nonphysician clinicians. JAMA 1998; 280:788-794.