Diagnosis: Too Many Physicians Study Predicts Surplus In Field Of Health Care

In the same way that cavity-fighting fluoride shrunk the public’s need for dentists, the trend to more efficient, managed-care health systems is reducing demand for doctors, nurses and pharmacists, a new study said Thursday.

The study, issued by the San Francisco-based Pew Health Professions Commission, warns of a massive glut of health-care workers ahead, and recommended that one in five of the nation’s medical schools be closed over the next 10 years.

The 21-member panel predicted that market-driven changes in health-care delivery will result in up to half of all U.S. hospitals being shuttered by the year 2000, along with the “loss of perhaps 60 percent of hospital beds.”

The panel forecast surpluses of 100,000 to 150,000 doctors, 200,000 to 300,000 nurses and 40,000 pharmacists over the same time period. It said the dwindling number of hospitals will be accompanied by an increased focus on primary care, community-based clinics and outpatient services.

The study acknowledged that despite the glut, many Americans lack adequate health care. But it said the oversupply problem would be a drain on public education budgets during a time of limited resources. It costs taxpayers $200,000 to train one physician, commission officials said.

“We need good medical schools,” said Edward O’Neil, the commission’s director. “But we don’t need 127 of them.”

The most likely response to the problem by medical school officials will be to reduce class sizes rather than close their doors, the study said. But that course would result in an anemic, less cost-efficient training system, it cautioned.

“We’re not naive,” O’Neil said. “We don’t believe that deans will throw themselves on their swords” and shut down entirely. But when medical schools are transformed from cash cows to “a hemorrhage of red ink” in campus budgets, university presidents may change their minds about closing them, he said.

The commission’s chairman, former Colorado Gov. Richard Lamm, praised the Republican-led Congress for addressing the issue in a Medicare reform bill. The bill, which has come under criticism from teaching hospitals, would limit the number of residents the federal government would fund.

“I’m impressed that Congress is at least asking the right questions,” said Lamm, a Democrat.

The most likely to survive a shake-out are Ivy League medical centers doing cutting-edge biomedical research and schools that have already shifted their mission to producing primary-care providers. The most likely targets for closing, meanwhile, are middle-tier campuses focused on producing subspecialists.

The study also recommended the following:

A reduction in the number of first-year medical students from 17,500 in 1995 to 13,000 to 14,000 in 2005.

Reduce the number of pharmacy schools and colleges by 20 percent to 25 percent. There are 75 in the United States.

A tightening of immigration laws to ensure that foreign students return to their native countries after they complete training.

Revamping of training programs so that at least 50 percent of them focus on primary-care areas such as family or general internal medicine by the year 2000.

The recommendations drew immediate fire from the American Nurses Association, which said the projected need for fewer nurses was based on faulty assumptions.