Group Practices Serving HMOs Employ Fewer Doctors Per Enrollee
Than The National Rate, Health Affairs Article Says

Analysis Of Medical Group Staffing Calls Into Question
Warnings That The United States Is Facing Shortage of Physicians

BETHESDA, MD — Large physician group practices serving three major health maintenance organizations operate with a physician-to-patient ratio that is up to 37 percent lower than the national rate, raising questions about recent warnings that the United States is facing a physician shortage, according to a new analysis published today on the Health Affairs Web site.

Jonathan Weiner, a professor and deputy director of the Health Services Research and Development Center at the Johns Hopkins Bloomberg School of Public Health in Baltimore, reviewed staffing at eight large prepaid group practices serving eight million enrollees of Kaiser Permanente, Group Health Cooperative in Seattle, and HealthPartners in the Minnesota Twin Cities to judge how their staffing ratios compare with the nation’s at large.
While representing only a small portion of U.S. practice, large, capitated medical groups are often used to assess health care staffing needs because they serve a defined population, while the health care system at large, with its reliance on fee-for-service care, has no similar yardstick for comparison.

Weiner finds that medical groups serving Kaiser Permanente employed 138.9 physicians per 100,000 enrollees, while those serving Group Health Cooperative employed 144.3 per 100,000 and HealthPartners medical groups employed 133.6 per 100,000. By contrast, the United States has a total of 228.9 physicians per 100,000 population.

“Over the past few years, interest in assessing the `adequacy’ of the U.S. medical workforce has increased dramatically,” Weiner says. “This study provides evidence that organized (group practices) in urban and suburban areas provide high-quality, cost-effective care to a diverse insured population with considerably fewer physicians than are now available in the nation at large.”

“The findings of this paper indicate that U.S. policymakers should deliberate carefully before concluding that expansion of medical training programs is warranted, especially given the huge taxpayer subsidy associates with supporting the training of each new medical professional,” he says.
Weiner also examined the groups’ ratio of primary care and specialist physicians, as well as nonphysician practitioners. In all cases, the ratio of practitioners to enrollees was lower than in the United States at large. In fact, Weiner writes, Group Health Cooperative and HealthPartners both had lower specialist-to-enrollee ratios than generalist-to-enrollee ratios.

“At the well-organized [practices], it is likely that internal medicine subspecialists (and certain other non-primary care physicians) are serving as true referral specialists, while in [fee-for-service] practice, a mix of specialty and general care is not uncommon for these providers,” Weiner writes.
Six perspectives accompany Weiner’s article. W. Bruce Fye, immediate past president of the American College of Cardiology, argues that there is likely a coming shortage of cardiologists because “several scientific, social, and demographic `demand catalysts’ outweigh factors that might decrease demand for cardiologists during the next decade.” Stephen C. Schoenbaum, senior vice president of the Commonwealth Fund in New York City, writes that because capitated group practices aren’t likely to become the standard method of health care delivery, the United States should learn how to emulate their methods to improve health care quality and efficiency. David C. Goodman, associate professor of pediatrics and community and family medicine at Dartmouth Medical School's Center for the Evaluative Clinical Sciences, writes that changing our view of physician productivity, not increasing their numbers, will help improve medical care in many locales. And Fitzhugh Mullan, a practicing physician and contributing editor of Health Affairs, writes about the medical care system’s failure to coordinate care for his dying father.

To read Weiner’s article, click content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.43.

Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary journal devoted to publishing the leading edge in health policy thought and research.

©2004 Project HOPE–The People-to-People Health Foundation, Inc.