Physician supply trends for primary care doctors and specialists

Health care reform continues to be a key political topic of discussion in the U.S. Physician supply and specialty training are important elements in designing an efficient system that provides the highest quality of care.

To understand where U.S. physician supply and specialty training is headed, I examined the U.S. trends from 1990 to 2007 (latest year data is available).

Physician supply has been growing during this period. In 1990, there were 615,000 physicians in the U.S. and by 2007 this figure had increased by 53% to 941,000. This came during a period when the total U.S. population increased approximately 25%

Which specialties are growing at rates higher than the total overall physician growth rate? Surprisingly, the primary care specialties all grew at a rate above 53%. The top five specialties in growth rate included: emergency medicine 116%, physical medicine and rehabilitation 101%, pediatrics 85%, family practice 77% and pulmunology 72%. In addition, the number of physicians in internal medicine grew by 61% over this period.

The high growth rate in emergency medicine physicians probably reflects growth in emergency medicine residency-trained doctors replacing and supplementing other specialty physicians who work in the emergency room.

Which specialties grew at a rate slower than average? The bottom five specialties for growth from 1990 to 2007 were: general surgery -2%, urology 12%, ophthalmology 13%, psychiatry 18% and pathology 19%. A shortage of general surgery doctors is generally recognized and recent plateaus in the supply in this specialty contributes to this problem. Lagging growth rates in psychiatric physicians may pose challenges to implemented extended mental health coverage planned for the U.S.

Female physician numbers grew at a rate of 156% over this period. Female physicians now account for 28% of all physicians in the U.S. compared to 17% in 1990. Female physicians have different specialty selection preferences and working patterns than men. These differences will affect how the physician workforce evolves in the next ten to twenty years.

Primary care physician specialty designation (internal medicine, pediatrics and family medicine combined) now makes up 34% of all physicians, up from 30% in 1990. Addressing the primary care shortage will require support for residency training in these specialties and reduction in payment gaps.

In summary, the recent trend in physician supply in the U.S. shows significant growth over the general population rate. Primary care physician numbers are also growing faster than other specialties. Planning for future physician supply will need to understand this trend and recognize the growing portion of female physicians.

William Yates is a family physician who blogs at Brain Posts.

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  • csmith

    There are now 28,000 hospitalists in the US. I would guess that 100% of the growth in Internal medicine has gone to the growth in the number of hospitalists not the provision of primary care.

  • http://www.brainposts.blogspot.com Bill

    This is an important point. The U.S. physician data is summary data and does not tell us details about practice settings. The number of internists has increased by 60,000 over this period, so a reasonable estimate is that hospitalists account for 50% of the increase.

  • http://www.drmintz.com Matthew Mintz

    Only 2% of US grads going into Internal Medicine plan on going into primary care. Most will go into hospital medicine or subspecialty IM.

  • LynnB

    The primary reason female physician choose different specilaties is that they listened during their OB/gyn rotation . Yes, women do deliver healthy babies in their 40′s. A sensible person doesn’t count on it. IF one fished med school at 26 and residency at 29 fertility is already declining. The shortest specialty tracks have you out in early 30′s. Assuming you have no interest in academia and don’t want to do research and all goes quickly you might be starting in your practice at 35. . If you start even 2-3 years later than that , which most do now, biology dictates that you will be interested in primary care even if you weren’t interested in it during med school or residency. I call it “the placental ceiling”. I would be fascinated to know how much of the growth in primary care was due to the fact most women must choose kids or fellowship, not both (there are exceptions, I know that) rather than the attractiveness of the primary care specilaties. I would aagree with Dr. MIntz comment on IM training . I think calling emergency medicine a primary care specialty is a telling comment on the train wreck condition of primary care practice in this country.

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