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May 6, 1998

Alternative Careers for Physicians

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JAMA. 1998;279(17):1398. doi:10.1001/jama.279.17.1397

Last year, a consensus statement from the American Medical Association, Association of American Medical Colleges, and 4 other groups declared that there is "compelling evidence" that the United States is on the verge of a physician oversupply crisis.1 One widely cited author estimated that by the year 2000 there may be as many as 165000 physicians more than required by a managed care–based system.2 Already, the United States is burdened with a significant excess of physicians. The current supply of about 200 physicians per 100000 population outstrips the 145 to 185 ratio that is generally agreed to be appropriate for a managed care–dominated system.3

In an effort to forestall this crisis, many leaders are calling for the federal government to limit residency positions.4 In 1997, a demonstration program was implemented in New York State that coordinated the exchange of Medicare benefits for voluntary decreases in residency positions, resulting in a decrease of 2228 residency positions.5,6 Encouraged by the success of this program, the Balanced Budget and Taxpayer Relief Acts of 1997 allocated $7 billion per year to extend this opportunity to hospitals throughout the country.5,6

While many authors remain pessimistic about the future for thousands of unemployed US physicians over the next 1 to 2 decades, some maintain that such concern is unnecessary. Market forces will prevail, according to health economist Uwe Reinhardt, and trained physicians will seek out and mold alternative career paths.7 This issue of Pulse focuses on alternative career options that today's physicians can anticipate in the near future. Suzanne Fraker discusses some of the options for which an MD degree may be particularly suited.

Two articles address some specific areas in which physicians will likely be employed. Scott Eggener describes a profession that has gained increased public attention in recent years—medical journalism. John Timpane writes on the 2 fields that are likely to be the most abundant and lucrative source of employment for physicians: pharmaceuticals and biotechnology.

The United States is not the only country where physicians are overabundant. Japan, France, and Germany all face physician surpluses of their own8; and in recent years the Czech Republic has also faced a severe physician oversupply.9 The destiny of excess physicians in the Czech Republic, argues Bohdan Pomahac and coauthors, may serve as a predictor of how successful their Western counterparts will be in finding desirable employment.

Karie Praszek notes that the perceived surpluses are mostly categorical and geographical. While the national supply of physicians is 200 per 100000 population, there is a dearth of practitioners in rural and inner-city regions, where the supply averages 30 per 100000 population. It is estimated that 11000 physicians are needed to bring this figure up to 50 per 100000 population, which is thought to be the acceptable minimum for any region.2

The future for US physicians is full of uncertainty—but also full of opportunities. Tomorrow's doctors should not be unemployed; rather, they should be redefined.

Not Available, http://www.aamc.org/newsroom/aamcstat/030397.htm#med. Accessed March 30, 1998.
Weiner  JP Forecasting the effects of health reform on US physician workforce requirements.  JAMA. 1994;272222- 230Google ScholarCrossref
Cooper  RA Seeking a balanced physician workforce for the twenty-first century.  JAMA. 1994;272680- 687Google ScholarCrossref
Rivo  MLKindig  DA A report card on the physician workforce in the United States.  N Engl J Med. 1996;334892- 896Google ScholarCrossref
Culliton  BJ US government pays hospitals not to train doctors.  Nat Med. 1997;31057Google ScholarCrossref
Cohen  JJ From the president: a little help for rightsizing residencies.  Acad Med. 1997;72984Google ScholarCrossref
Reinhardt  U The impending physician surplus: is it time to quit?  JAMA. 1997;27769Google ScholarCrossref
Nathan  R Japan proposes physician cutbacks.  Nat Med. 1997;31057Google ScholarCrossref
Ministry of Health Care, Czech Health Statistics Yearbook 1995.  Prague, Czech Republic Ustav Zdravotnickych informaci a statistiky Ceske Republiky [Institute for Health Care Information and Statistics of the Czech Republic]1996;91118- 123