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December 20, 1995

Projections for the Generalist Physician Workforce

Author Affiliations

University of Washington Veterans Health Administration Seattle

JAMA. 1995;274(23):1833-1834. doi:10.1001/jama.1995.03530230019011

To the Editor.  —The argument by Dr Whitcomb1 that the number of generalist physicians in the United States is adequate is flawed for four reasons.First, it adheres slavishly to the physician-population ratio as an instrument of public policy. I pointed out in 1975 that there was no correlation between the physician-population ratio and the quality of care both cross-nationally and within the United States.2 This ratio also ignores maldistribution between generalists and specialists and by geography. More important, Whitcomb's interpretation comparing generalist physician-population ratios between countries is misleading because it ignores the total number of physicians in the workforce. England is a case in point; while its generalist-population ratio is only 54:100 000, generalists comprise 59% of the physician workforce. In the United States, where the ratio is 69:100 000, generalists comprise only 34% of the workforce.Second, cross-national comparisons of physician workforces are fraught with danger

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