Health manpower supply and demand: The case of a family practice residency program

In view of increasing requirements for health care and climbing costs that reflect scarcer resources, it is necessary that new health care delivery facilities and medical personnel training programs be carefully planned. Care must be taken not to concentrate efforts on progress in medical science technology exclusively. Basic problems exist in the delivery of health care, e.g. maldistribution of physicians by specialty and geographic location and inequitable patterns of availability of health care facilities and personnel. A number of techniques have been used by health planners to forecast the need for, demand for and supply of health manpower at a specific time and place. The basic models for estimating these requirements include those based on: (1) professionally defined criteria, (2) current utilization rates of comprehensive pre-paid group plans, (3) medical personnel to population ratios, and (4) economic systematics. Some of these models address need (quantity of medical care that ought to be consumed to be as healthy as medical technology permits); others focus on supply and demand (actual use of medical services by consumers as a function of age, income, education, travel costs, and other social, economic and demographic variables).

After a review of the available models, it was felt that the economic types were most useful because they allow for the simulation of change in the health care environment and accommodate “what if” questions, thereby allowing for the consideration of contingencies in the environment. One example of a significant change in the health care environment in the United States would be the decrease or elimination of foreign medical graduates; FMG's accounted for 47% of the newly licenced physicians in the U.S. in 1974.

The economic model presented in this study was used to assess the supply of and demand for primary care physicians, particularly family practitioners in metropolitan northern Virginia. The demonstration of the model reveals its great flexibility b.y presenting four alternative situations for each of the study years 1978, 1988 and 1993. The statement of demand for family practitioners in this region was incorporated as a major phase of a feasibility study by the Medical College of Virginia for a family practice residency program at the Mount Vernon Hospital.