In the first act I left a gun on the wall. I questioned whether there was a physician shortage in the US.

The rule of drama is that a gun on the wall in the first act has to be used later in the play. Let’s look at the US physician shortage.

We want to determine: is there really a shortage? what is the nature of the shortage? if there is a shortage, do the measures proposed address that shortage?

The AAMC claims that the shortage has resulted from the cap on Medicare-funded residencies implemented under the Balanced Budget Act of 1997.

I wanted to find a time series on the number of physicians from 1997 to the present. It may be that the AAMC and AMA have such a series but it would be time-consuming, even if possible, to get hold of those figures.

Consequently I went to the Bureau of Labor Statistics (BLS) for physician employment and to the US Census Bureau for population figures. Also, the BLS changed the way it classified and calculated numbers of health care practitioners. The BLS has confirmed to me that the physician totals for 1999-2003 do not exist, although some sub-totals do.

First, I compared the number of physicians to the US population. I simply divided the number of physicians by the population and multiplied by 1000 to get physicians per 1000 population, yielding this graph:

Now that does not look like a physician shortage–indeed, it looks like we may have a physician surplus with the growth in the number of physicians outstripping population growth.

So, I looked a bit further. I grouped pediatricians, general internists, and family practice physicians, calling them “Primary Care.” Then, I produced this graph, indexing them to 2004 being 100 so we could see the relative growth.

It is clear that while the total number of physicians has grown faster than the population, the number of primary care physicians has trailed.

Since we have the sub-categories going back to 1999, just after the Balanced Budget Amendment of 1997 was passed, here is the indexed comparison:

While the number of Primary Care Physicians kept pace with the population from 2004 through 2007, it has generally fallen short of population growth.

The challenge then is: how do we allocate resources to increase the number of physicians in primary care without those funds being diverted to creation of even more specialists?