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PubMed1995

Graduate medical education and physician practice location. Implications for physician workforce policy.

OBJECTIVE: To determine the relationship between graduate medical education and physician practice location. DESIGN: Cross-sectional analysis of physicians in active practice in 1993, classified by state of graduate medical education and stratified by specialty and professional activity. Logistic regression analysis was used to examine predictors of physicians remaining to practice in the same state in which they trained. SETTING: There were 82,871 allopathic physicians (national random sample) and 15,076 osteopathic physicians (universe) who completed graduate medical education between 1980 and 1992. MAIN OUTCOME MEASURE: Practice location in the same state as graduate medical education. RESULTS: Overall, 51% of physicians are practicing in the state in which they obtained their graduate medical education (range among states, 6% to 71%). Generalist physicians are more likely than specialists to remain in their state of graduate medical education (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.33 to 1.40) There is a weak negative association between the number of physicians in training per capita in a state and the likelihood of a physician remaining in the state to practice (OR, 0.90; 95% CI, 0.90 to 0.91, for an increment in resident supply of 10 per 100,000 population). New York and Massachusetts, the states with the highest numbers of residents per capita, retained 51% and 49%, respectively, of their graduates, placing them near the median among states. CONCLUSIONS: Most physician training and practice locations function as a national market, with physicians dispersing relatively widely after completing graduate medical education. States that produce high numbers of physicians per capita do not appear to play a unique role in training physicians to serve a national market. These findings pose challenges for states attempting to modify their physician supply and specialty mix.

Cross-Sectional Studies↗
PubMed1994

Will the power of the marketplace produce the workforce we need?

The medical manpower market will work best as an agent for change in primary care when there is vigorous demand, a sophisticated buyer, and not too large a gap to fill--conditions that we can expect with managed care growth in U.S. urban settings in the next decade. In these circumstances, the primary care supply will adjust without the need for regulatory intervention. The most dramatic workings of the market will be in stripping from the system the excess payments for practicing subspecialist physicians. However, market forces will not quickly moderate the growing oversupply of doctors nor their maldistribution to areas of need. Focused public policy manpower interventions will be needed to correct these deficits quickly.

Economic Competition↗
PubMed1994

Health care workforce priorities: what nursing should do now.

We provide an appraisal of the adequacy of the aggregate supply of nurses and the appropriateness of their educational mix in view of anticipated changes in health care. We view the supply as adequate, but the educational mix as deficient with regard to nurses with baccalaureate and higher degrees who will be in greatest demand in new and expanding roles. Five priority areas are identified in which nursing can make particularly important contributions to improving health and health care: restructuring hospitals, improving primary care availability, contributing to the viability of academic health centers, improving care of the underserved, and redesigning the role of public health in a reformed health care system.

Education, Nursing↗