To the Editor.
—In regard to Dr Weiner's1 article on the physician staffing that will be required with health system reform, I would like to be assured that the comparison of staffing patterns in nephrology between HMOs and the US supply is a valid one. Because the prevalent end-stage renal disease population (in December 1991) was 721 patients per million population2 and since a substantial fraction of nephrologists' clinical work is in the care of end-stage renal disease patients, it is important to know the prevalence of such patients in the 16 HMOs used for the comparison. In this group, the nephrology staffing was 0.6 to 0.9 nephrologist per 100 000 population compared with 1.1 per 100 000 in the United States. I hope that Weiner will provide this information.The adjusted end-stage renal disease prevalence rate is growing at an average rate of 9.3% per year, but
Levin NW. Forecasting Physician Workforce Requirements. JAMA. 1995;273(2):112. doi:10.1001/jama.1995.03520260031018