Behind the physician licensure numbers: false impressions, retirement crisis, and migration.

Olchanski V; Marsland DW; Rossiter LF; Johnson RE
Virginia Commonwealth University, Richmond, USA. volchans@vcu.edu

Clin Perform Qual Health Care. 1998 Jul-Sep;6(3):142-6.

• the number of actively practicing physicians is considerably less than the number of licensed physicians;
• the age distribution of primary-care physicians has a bulge in the ages younger than 50, and this bulge may lead in the near future to an unexpected sudden increase in physician attrition due to retirement; and,
• at the state level, migration may be playing the dominant role in determining the total supply of primary-care physicians.

Primary-care--physician supply: policy analysis on the state level.

Olchanski V; Marsland DW; Rossiter LF; Johnson RE
Virginia Commonwealth University, Richmond, USA. volchans@vcu.edu

Clin Perform Qual Health Care. 1998 Jul-Sep;6(3):129-37.

To describe a method for policy analysis on the state level for understanding frequently overlooked determinants of the current status and dynamics of primary-care-physician supply.

The method used is systems analysis. The approach takes account of the changing interstate migration, tracking the professional origins of physicians, their uneven age distribution, and the considerable time delays in the system. The forecasting mathematical model consists of the physician-aging submodel, the undergraduate and graduate medical education submodel, and the migration subsystem.

The necessary data were restored fully from the Virginia Board of Medicine archive database.

The analysis shows the outstanding importance of out-of-state migration for the state of Virginia: approximately two thirds of primary-care physicians are out-of-state medical graduates. In the next decade, the attrition of primary-care physicians will start to suddenly increase because of the prominent bulge in the physician age distribution. Similar bulges were observed in the age distributions for some other states.

The method reveals the underlying mechanisms and principles of physician work-force reproduction. It may show which goals are feasible, and it may be used in any state for the research necessary for rational policy formulation.