Physician manpower needs under managed care. How to determine the need for MDs by specialty

The concern in the last quarter century in the United States over the shortage of physicians has now been supplanted by the fear of an excess number of doctors, particularly among the subspecialists. This article outlines four methodologies to be used in parallel to determine by clinical specialty whether a predetermined population base has an inadequate, sufficient, or excess number of physicians. Based on various assumptions, physician-population ratios per 100,000 persons for 28 clinical disciplines are supplied. Possibly the most intriguing questions as a result of this study are whether a broad spectrum of HMOs will use general internists or family practitioners as their prime "gatekeepers;" and, whether, in the long-run, the fiscal incentives inherent in the managed care concept will result in a more frugal utilization of physician services.