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Rich66 · 10-21-2009, 04:00 PM

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From Medscape Medical News

Current Estimates Predict Fewer and Younger MDs in the Future

Fran Lowry

October 20, 2009 — Estimates made using data from the US Census Bureau suggest that the future physician workforce may be younger and fewer in number, contrary to estimates made using the American Medical Association Physician Masterfile data, a source that is often used by workforce analysts to project changes in the supply of physicians, according to the results of a study published in the October 21 issue of the Journal of the American Medical Association.
"Recent projections indicate that the supply of US physicians may soon decrease below requirements, with some projecting a shortfall as high as 200,000 by 2020," write Douglas O. Staiger, PhD, from Dartmouth College, Hanover, New Hampshire, and the National Bureau of Economic Research, Cambridge, Massachusetts, and colleagues. "Although debate over potential shortages has focused largely on the number and type of physicians needed in the future, concerns have also been raised about data used in physician supply estimates and projections."
The Masterfile data have recently come under scrutiny because of concerns that the Masterfile overestimates the number of active physicians at older ages, the authors write.
The aim of this study was to compare physician workforce estimates and supply projections using Masterfile data with estimates and projections using data from the US Census Bureau Current Population Survey (CPS), a data source used extensively by the US Department of Labor.
Using annual data from the Masterfile and the CPS between 1979 and 2008, the investigators analyzed the number of active physicians by age and sex to estimate the annual number of physicians working at least 20 hours per week in 10-year age categories.
The authors found that in an average year, the CPS estimated 67,000 fewer active physicians (10%) than did the Masterfile (95% confidence interval [CI], 57,000 – 78,000; P < .001), almost entirely as a result of there being fewer active physicians aged 55 years or older.
They also found that the CPS estimated more young physicians (ages 25 – 34 years) than did the Masterfile, with the difference increasing to an average of 17,000 physicians (12%) during the final 15 years (95% CI, 13,000 – 22,000; P < .001).
The CPS estimates of more young physicians were consistent with historical growth observed in the number of first-year residents, and their estimates of fewer older physicians were consistent with lower Medicare billing by older physicians, the authors note.
Both databases projected that the number of active physicians will increase by approximately 20% between 2005 and 2020. However, the CPS data estimated that there will be almost 100,000 fewer active physicians (9%) than the Masterfile data (957,000 per CPS vs 1,050,000 per Masterfile). The CPS data also estimated that a smaller proportion of active physicians will be aged 65 years or older (9% vs 18%).
"The CPS-based projection indicates that 71% of active physicians will be younger than 55 years and only 9% will be older than 65 years, whereas the Masterfile-based projection indicates that 61% of active physicians will be younger than 55 years and 18% will be older than 65 years," Dr. Staiger and colleagues write.
In addition, the increasing proportion of female physicians had little effect on physician supply projections "because, unlike male physicians, female physicians were found to maintain their work activity after age 55 years," according to the authors.
The analysis was restricted to physician supply and projections of physician requirements also rely on estimates of the current number of physicians as a starting point for projections. "Thus, without more accurate estimates of the size and age distribution of the current workforce, projections of physician supply, requirements, and potential shortages may mislead policymakers as they try to anticipate and prepare for the health care needs of the population," the authors conclude.
In an accompanying editorial, Thomas C. Ricketts, PhD, MPH, from the University of North Carolina, Chapel Hill, writes that the controversy over the accuracy of the Masterfile data continues the "longstanding" debate over the supply of physicians and whether that number meets the US healthcare needs and promotes economic efficiency.
"The physician workforce is one of the most critical factors that must be considered in current health care reform and discussions," he writes. "Having accurate estimates for determining not only the number of physicians, but also current and future physician and workforce requirements and capabilities for delivering primary and specialty care, will be essential for achieving and sustaining effective health care reform."
Dr. Staiger and Dr. Ricketts have reported no relevant financial relationships.
JAMA. 2009;302:1674–1680, 1701–1702.
[CLOSE WINDOW]
Authors and Disclosures

Journalist

Fran Lowry

is a freelance writer for Medscape.

Medscape Medical News © Medscape, LLC
Send press releases and comments to news@medscape.net.

10-21-2009, 04:00 PM	#6
Rich66 Senior Member Join Date: Feb 2008 Location: South East Wisconsin Posts: 3,431	Re: Medicare facing cancer, cardiac care cuts www.medscape.com From Medscape Medical News Current Estimates Predict Fewer and Younger MDs in the Future Fran Lowry October 20, 2009 — Estimates made using data from the US Census Bureau suggest that the future physician workforce may be younger and fewer in number, contrary to estimates made using the American Medical Association Physician Masterfile data, a source that is often used by workforce analysts to project changes in the supply of physicians, according to the results of a study published in the October 21 issue of the Journal of the American Medical Association. "Recent projections indicate that the supply of US physicians may soon decrease below requirements, with some projecting a shortfall as high as 200,000 by 2020," write Douglas O. Staiger, PhD, from Dartmouth College, Hanover, New Hampshire, and the National Bureau of Economic Research, Cambridge, Massachusetts, and colleagues. "Although debate over potential shortages has focused largely on the number and type of physicians needed in the future, concerns have also been raised about data used in physician supply estimates and projections." The Masterfile data have recently come under scrutiny because of concerns that the Masterfile overestimates the number of active physicians at older ages, the authors write. The aim of this study was to compare physician workforce estimates and supply projections using Masterfile data with estimates and projections using data from the US Census Bureau Current Population Survey (CPS), a data source used extensively by the US Department of Labor. Using annual data from the Masterfile and the CPS between 1979 and 2008, the investigators analyzed the number of active physicians by age and sex to estimate the annual number of physicians working at least 20 hours per week in 10-year age categories. The authors found that in an average year, the CPS estimated 67,000 fewer active physicians (10%) than did the Masterfile (95% confidence interval [CI], 57,000 – 78,000; P < .001), almost entirely as a result of there being fewer active physicians aged 55 years or older. They also found that the CPS estimated more young physicians (ages 25 – 34 years) than did the Masterfile, with the difference increasing to an average of 17,000 physicians (12%) during the final 15 years (95% CI, 13,000 – 22,000; P < .001). The CPS estimates of more young physicians were consistent with historical growth observed in the number of first-year residents, and their estimates of fewer older physicians were consistent with lower Medicare billing by older physicians, the authors note. Both databases projected that the number of active physicians will increase by approximately 20% between 2005 and 2020. However, the CPS data estimated that there will be almost 100,000 fewer active physicians (9%) than the Masterfile data (957,000 per CPS vs 1,050,000 per Masterfile). The CPS data also estimated that a smaller proportion of active physicians will be aged 65 years or older (9% vs 18%). "The CPS-based projection indicates that 71% of active physicians will be younger than 55 years and only 9% will be older than 65 years, whereas the Masterfile-based projection indicates that 61% of active physicians will be younger than 55 years and 18% will be older than 65 years," Dr. Staiger and colleagues write. In addition, the increasing proportion of female physicians had little effect on physician supply projections "because, unlike male physicians, female physicians were found to maintain their work activity after age 55 years," according to the authors. The analysis was restricted to physician supply and projections of physician requirements also rely on estimates of the current number of physicians as a starting point for projections. "Thus, without more accurate estimates of the size and age distribution of the current workforce, projections of physician supply, requirements, and potential shortages may mislead policymakers as they try to anticipate and prepare for the health care needs of the population," the authors conclude. In an accompanying editorial, Thomas C. Ricketts, PhD, MPH, from the University of North Carolina, Chapel Hill, writes that the controversy over the accuracy of the Masterfile data continues the "longstanding" debate over the supply of physicians and whether that number meets the US healthcare needs and promotes economic efficiency. "The physician workforce is one of the most critical factors that must be considered in current health care reform and discussions," he writes. "Having accurate estimates for determining not only the number of physicians, but also current and future physician and workforce requirements and capabilities for delivering primary and specialty care, will be essential for achieving and sustaining effective health care reform." Dr. Staiger and Dr. Ricketts have reported no relevant financial relationships. JAMA. 2009;302:1674–1680, 1701–1702. [CLOSE WINDOW] Authors and Disclosures Journalist Fran Lowry is a freelance writer for Medscape. Medscape Medical News © Medscape, LLC Send press releases and comments to news@medscape.net.