| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Guest Access | Sign In via User Name/Password
|
|
|
|||||||
Guest Access | Sign In via User Name/Password |
|||||||||
Dr. Pingleton is a Professor of Medicine and Director, Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center.
Correspondence to: Susan K. Pingleton, MD, FCCP, Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, KS 66160; e-mail: spinglet{at}kumc.edu
For 20 years, multiple manpower studies have proclaimed the existence of a physician surplus. In 1976, the Graduate Medical Education National Advisory Committee (GMENAC) predicted a 22% physician surplus by 2000.1 In the early 1990s, the Committee on Graduate Medical Education not only predicted a physician surplus, but they warned of a maldistribution of primary care and specialty care physicians.2 Generalists would be in short supply, but a dramatic oversupply of specialists would exist by the year 2000.
Many remember the resultant discussions and strategic initiatives implemented in academic medical centers and directed specifically to increasing the proportion of generalists. My own state-supported medical school was mandated by the legislature to increase the percentage of generalists trained or risk losing state support.
In 1995, alarmed by these and other reports, fellowship training directors and the leadership of the American College of Chest Physicians (ACCP), the Society of Critical Care Medicine, and the American Thoracic Society convened in Chicago, IL. In a subsequent editorial, Hunninghake et al3 described the group’s most compelling concern as the prospect of training physicians who would, subsequently, be unable to obtain meaningful and gainful employment.
After much discussion, it was decided that specific pulmonary and critical care manpower data were required before further decisions could be made, although many training programs unilaterally decided to decrease training slots.
The Committee on Manpower of Pulmonary and Critical Care Societies (COMPACCS) was born. Working cooperatively were two representatives from each of the three societies, plus representation from the Pulmonary and Critical Care Medicine (PCCM) and Critical Care Training Directors. Dick Briggs and myself were the ACCP representatives. The work was funded equally among the societies, an amount totalling over $250,000. The committee’s purpose was to describe the current demand and supply for pulmonary and critical care physicians, with the primary goal of developing a computer tool for assessing future demand and supply.
A methodologically rigorous, prospective, data-based study was developed and implemented. Importantly, the manpower forecasts were projected into the year 2030. The COMPACCS study is one of the few manpower studies to develop long-term projections. Based on data describing the current patient demand and physician supply for pulmonary and critical care, a computer model was created to project the future demand and supply for pulmonary and critical care services.
The COMPACCS report was recently published in the Journal of the American Medical Association.4 Quite surprisingly, and in contrast to previous manpower data, the COMPACCS data clearly show that demand for pulmonary and critical care physicians outstrips supply conservatively by the year 2007. Demand exceeds supply by almost 35% by the year 2030.
Clearly, the report predicts an avalanche of demand for pulmonary and critical care services in the United States within 5 to 15 years. Many pulmonary and critical care physicians recruiting for their own practices might argue that this increased demand has already begun.
A sensitivity analysis of variables that could potentially affect supply and/or demand was done. Examples of variables analyzed included changes in number of ICU diseases, changes in trainee numbers, and age at retirement. The only variable that would equalize demand and supply to 2030 would be to delay the age of physician retirement until age 77!
What accounts for this increased demand? Quite simply, it is the aging of the baby boomers. The initial cusp of retiring boomers will begin soon. The absolute numbers are staggering, and the impact on all aspects of our economy is only now being realized.
Why is the COMPACCS analysis different? First, many of the previous studies were not data driven. In the GMENAC report, demand was estimated by a panel of experts, not derived from a specific data survey as in the COMPACCS study.
Second, assumptions used in previous studies have not stood the test of time.5 One essential assumption for studies in the early 1990s was that almost 100% of patients would have their care delivered by HMOs or other models of managed care. This hasn’t happened. While penetration of managed care is high in urban areas, many other areas have a low penetration of managed care. Fee-for-service care still exists, and it is growing in popularity again in many areas of the country.
The COMPACCS report is very important for multiple reasons. Not to be underestimated is the importance of the collaboration of the three societies to achieve a common goal. The memberships believe that their societies should work together in areas of common interest. This was done, and, hopefully, the success of this endeavor will provide the basis for future endeavors.
Manpower assessment studies clearly show the danger of "driving while looking through the rear view mirror." By looking only backwards in our data and by failing to recognize the very dynamic nature of forces affecting patient demand and physician supply, we as a profession have embarked on policy initiatives that will be unsubstantiated in the future.
Is COMPACCS in danger of this same malady? You bet. Have things changed since the initial data collection 4 years ago? You bet. COMPACCS was always envisioned as a moving picture. Right now, all we have is a photograph of a single point in time. We need periodic evaluations using similar methodology to be able to rigorously defend our position and to make the most intelligent decisions regarding workforce and trainee planning.
The leaderships of the ACCP, the Society of Critical Care Medicine, and the American Thoracic Society have committed to revisit COMPACCS with a repeat survey. Efforts are currently underway to review the data survey methodology to update any areas. Specifically, the issues of hospitalists and pediatric intensivists are being explored.
Meanwhile, our professional societies must embark on strategies of physician workforce planning. Given this data, an intuitive conservative approach should include maintenance of the current supply of pulmonary and critical care physicians. Pulmonary and critical care trainee numbers should not be decreased. Multiple other strategies need to be considered and addressed.
The COMPACCS report has a wealth of data in addition to projections for the future. Characteristics of physician practice and work are delineated for pulmonary and critical care physicians. I urge you to read this report for yourself. Also, if you receive a COMPACCS survey in the future, please fill it out. Your responses are how we can best determine manpower and workplace issues.
References
This article has been cited by other articles:
|
|
 |
|
  J. C. Arnett Jr, J. M. Orient, and S. K. Pingleton Physician Workforce and Trainee Planning Chest, April 1, 2002; 121(4): 1376 - 1377. [Full Text] [PDF]
|
|
|
|
|
|
A. J. Block Is Anyone Paying Attention? Chest, November 1, 2001; 120(5): 1431 - 1432. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
