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Are we training too many medical subspecialists?
W B Schwartz1, A P Williams, J P Newhouse
1Department of Medicine, Tufts University School of Medicine, Boston, MA 02111.
JAMA
|January 8, 1988
Summary
Many large cities lacked sufficient board-certified medical subspecialists in 1983. Projections indicate this physician shortage will persist even by the year 2000, impacting access to specialized care.
Area of Science:
- Medical Economics
- Health Services Research
Background:
- In 1983, significant gaps existed in board-certified physician coverage across various medical subspecialties in cities with populations between 125,000 and 500,000.
- Many cities of this size had limited or no board-certified specialists in numerous fields, and even including non-certified internists with declared subspecialty interests did not resolve the coverage issue.
Purpose of the Study:
- To assess the extent of board-certified physician subspecialist coverage in U.S. cities of varying population sizes.
- To project future availability of subspecialists and identify potential persistent shortages.
Main Methods:
- Analysis of physician certification data in relation to city population size.
- Estimation of future subspecialist supply and demand based on demographic and healthcare utilization trends.
Main Results:
- In 1983, 10% to 40% of cities (200,000-500,000 population) lacked board-certified physicians in at least one subspecialty.
- Smaller cities (125,000-200,000 population) exhibited even poorer subspecialist coverage.
- Despite projected increases in subspecialists by 2000, significant deficits in most subspecialties are anticipated for many large cities.
Conclusions:
- A substantial number of large and medium-sized cities faced inadequate access to board-certified medical subspecialists in 1983.
- Anticipated growth in subspecialist numbers and demand suggests that physician shortages in these areas will likely continue through the year 2000.