Gaps in the Supply of Physicians and other Advanced Clinicians

A new paper in the Journal of the American College of Surgeons assesses the likelihood that the combined supply of physicians, advance practice nurses and physician assistants will be sufficient to provide the clinical services that health care reform will demand.

The paper was authored by Michael Sargen, a Penn medical student, Rod Hooker, an authority on physician assistants and other nonphysician clinicians and a member of The Lewin Group, and Buz Cooper, who has published authoritative projections of the physician workforce over the past 15 years. A pre-publication copy of the paper is available online and a summary follows:

Gaps in the Supply of Physicians, Advance Practice Nurses and Physician Assistants

Based on the goals of health care reform, the demand for physicians will continue to increase. As physician shortages deepen, advanced practice nurses (APNs) and physician assistants (PAs) will play larger roles. Together with physicians they constitute a workforce of “advanced clinicians.” The objective of this study was to assess the capacity of this combined workforce to meet the future demand for clinical services.

Projections were constructed to the year 2025 for the supply of physicians, APNs and PAs, and these were compared with projections of the demand for advanced clinical services, based on federal estimates of future health care spending and historic relationships between spending and the size of the health care labor force.

If training programs for APNs and PAs grow as currently projected but physician residency programs are not further expanded, the aggregate per capita supply of advanced clinicians will remain close to its current level, which will be 20% less than the demand in 2025. Increasing the numbers of entry-level (PGY1) residents by 500 annually will narrow the gap, but it will remain >15%.

The nation faces a substantial shortfall in its combined supply of physicians, APNs, and PAs, even under aggressive training scenarios, and deeper shortages if these scenarios are not achieved. Efforts must be made to expand the output of clinicians in all three disciplines, while also strengthening the infrastructure of clinical practice and facilitating the delegation of tasks to a broadened spectrum of caregivers in new models of care.


  1. JamieK

    MD’s are killing each other over patients in the big cities. There is an oversupply of MD’s in big cities and an undersupply in rural areas. The additional 10% of patients can easily be handled in big cities. The rural areas are left to fend for themselves.

    • buzcooper

      Physicians may be killing each other for patients in Orange County, but JamieK’s ENT practice at UC Irvine is not killing anyone for straight Medi-Cal patients, who are not accepted. That’s typical. Only 65% of all physicians accept Medicaid and only 75% accept Medicare. Indeed, 15% of practices are closed to all new patients. So if there’s competition, it’s for patients who can pay. Rural areas were fairly well-served during the abundance of physicians in the 1990s, but as supply has declined, physicians gravitated to opportunities in large cities. That trend continues. There soon will be too few for the patients in most areas, and the patients who will suffer most will be the urban poor and residents of rural communities. So I agree with JamieK that rural areas are left to fend for themselves, and soon fending for one’s self will be the national norm.

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