Projections of physician supply in internal medicine: a single-state analysis as a basis for planning.
BACKGROUND: Physician supply planning has become an issue of increasing national debate over the past decade, particularly with the recent focus on health care reform. Most authorities agree that the United States has an increasing surplus of physicians. OBJECTIVE: The physician supply debate focuses on how to determine current and future physician supply and define appropriate specialty mix needs and then choose the measures that will appropriately influence the current and future size and specialty mix of the physician workforce. We examine these issues in the context of internal medicine in Connecticut, which may provide a single-state model for physician supply planning. METHODS: Data on the past and current supply of Connecticut internists and projections for future supply and need are examined. Particular attention is given to adult primary care (provided largely by general internists) and public policy implications. RESULTS: We find Connecticut has a disproportionate number of internists compared with the nation. Further, internist supply is growing faster than the population. Almost all subspecialties are in surplus and projected to increase further by the year 2000. CONCLUSIONS: Several approaches are available to limit excesses and produce more primary care physicians, including controls on residency and fellowship positions. Each approach presents both opportunities and challenges, and their implications must be carefully considered.