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Can We Meet the Requirements of an Aging Population?

Derek C. Angus, MB, ChB, MPH; Mark A. Kelley, MD; Robert J. Schmitz, PhD; Alan White, PhD; John Popovich, Jr, MD; for the Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS)

JAMA. 2000;284:2762-2770.

Context  Two important areas of medicine, care of the critically ill and management of pulmonary disease, are likely to be influenced by the aging of the US population.

Objective  To estimate current and future requirements for adult critical care and pulmonary medicine physicians in the United States.

Design, Setting, and Participants  Analysis of existing population, patient, and hospital data sets and prospective, nationally representative surveys of intensive care unit (ICU) directors (n = 393) and critical care specialists (intensivists) and pulmonary specialists (pulmonologists) (n = 421), conducted from 1996 to 1999.

Main Outcome Measures  Influence of patient, physician, regional, hospital, and payer characteristics on current practice patterns; forecasted future supply of and demand for specialist care through 2030. Separate models for critical care and pulmonary disease. Base-case projections with sensitivity analyses to estimate the impact of future changes in training and retirement, disease prevalence and management, and health care reform initiatives.

Results  In 1997, intensivists provided care to 36.8% of all ICU patients. Care in the ICU was provided more commonly by intensivists in regions with high managed care penetration. The current ratio of supply to demand is forecast to remain in rough equilibrium until 2007. Subsequently, demand will grow rapidly while supply will remain near constant, yielding a shortfall of specialist hours equal to 22% of demand by 2020 and 35% by 2030, primarily because of the aging of the US population. Sensitivity analyses suggest that the spread of current health care reform initiatives will either have no effect or worsen this shortfall. A shortfall of pulmonologist time will also occur before 2007 and increase to 35% by 2020 and 46% by 2030.

Conclusions  We forecast that the proportion of care provided by intensivists and pulmonologists in the United States will decrease below current standards in less than 10 years. While current health care reform initiatives and modification of existing practice patterns may temporarily forestall this problem, most anticipated effects are minor in comparison with the growing disease burden created by the aging US population.

Author Affiliations: Department of Anesthesiology and Critical Care Medicine and Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pa (Dr Angus); Department of Medicine, Henry Ford Hospital, Detroit, Mich (Drs Kelley and Popovich); and Mathematica Policy Research (Dr Schmitz), Abt Associates Inc (Dr White), Cambridge, Mass.

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