Health manpower trends in a market-driven environment

In the context of the American health system shifting to a more market-driven environment of networks and HMOs, this article focuses on the possible effects of these competitive strategies on the future demand for various categories of health manpower. The consolidation in healthcare resources by forming alliances and aligned HMOs, and the reduction in Medicare and Medicaid reimbursements have the impact of paying specialists less and generalists more. Some medical schools modified their curricula and encouraged more of their graduates to pursue family practice, general internal medicine, and pediatrics. Until recently, none of these efforts made a dent. Medical school graduates continue to find the specialties to be intellectually more rigorous, technologically more exciting, and know that they were still financially more rewarding than engaging in a primary care practice. And, the academic health centers continue to offer a large number of fellowships to supply the highly skilled, relatively inexpensive labor for delivering tertiary services. When completing their training programs, almost all subspecialists (anesthesiologists being among the exceptions) were still being recruited for positions that allowed them to make a comfortable living.