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An Alternative to Needs-Based or Demand-Based Planning

David C. Goodman, MD, MS; Elliott S. Fisher, MD, MPH; Thomas A. Bubolz, PhD; Jack E. Mohr; James F. Poage, PhD; John E. Wennberg, MD, MPH

JAMA. 1996;276(22):1811-1817.

Abstract
Objective.
—To propose population-based benchmarking as an alternative to needs- or demand-based planning for estimating a reasonably sized, clinically active physician workforce for the United States and its regional health care markets.

Design.
—Cross-sectional analysis of 1993 American Medical Association and American Osteopathic Association physician masterfiles.

Population.
—The resident population of the 306 hospital referral regions in the United States.

Main Outcome Measures.
—Per capita number of clinically active physicians by specialty adjusted for age and sex population differences and out-of-region health care utilization. The measured physician workforce was compared with 4 benchmarks: the staffing within a large (2.4 million members) health maintenance organization (HMO), a hospital referral region dominated by managed care (Minneapolis, Minn), a hospital referral region dominated by fee-for-service (Wichita, Kan), and the proposed "balanced" physician supply (50% generalists).

Results.
—The proportion of the US population residing in hospital referral regions with a higher per capita generalist workforce than the benchmark was 96% for the HMO benchmark, 60% for Wichita, and 27% for Minneapolis. The specialist workforce exceeded all 3 benchmarks for 74% of the population. The per capita workforce of generalists was not related to the proportion of generalists among regions (Pearson correlation coefficient=0.06; P=.26).

Conclusions.
—Population-based benchmarking offers practical advantages to needs- or demand-based planning for estimating a reasonably sized per capita workforce of clinically active physicians. The physician workforce within the benchmarks of an HMO and health care markets indicates the varying opportunities for regional physician employment and services. The ratio of generalists to specialists does not measure the adequacy of the supply of the generalist workforce either nationally or for specific regions. Research measuring the relationship between physician workforces of different sizes and population outcomes will guide the selection of future regional benchmarks.

Author Affiliations
From the Center for the Evaluative Clinical Sciences, Departments of Community and Family Medicine (Drs Goodman, Fisher, Bubolz, Poage, and Wennberg, and Mr Mohr), Pediatrics (Dr Goodman), and Medicine (Dr Fisher), Dartmouth Medical School, Hanover, NH; and the Department of Veterans Affairs Medical Center, White River Junction, Vt (Dr Fisher).

Footnotes
Reprints: David C. Goodman, MD, MS, 211 Strasenburgh Hall, Dartmouth Medical School, Hanover, NH 03755.

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