The Effects Of Specialist Supply On Populations’ Health: Assessing The Evidence

Abstract

Analyses at the county level show lower mortality rates where there are more primary care physicians, but this is not the case for specialist supply. These findings confirm those of previous studies at the state and other levels. Increasing the supply of specialists will not improve the United States' position in population health relative to other industrialized countries, and it is likely to lead to greater disparities in health status and outcomes. Adverse effects from inappropriate or unnecessary specialist use may be responsible for the absence of relationship between specialist supply and mortality. M a n y i n t e r nat i o na l c o m pa r i s o n s and within-country studies confirm the relationship between the adequacy of a health system's primary care infrastructure and better health outcomes.1 This study examines the heretofore unexplored relationship between specialist physician supply and death rates, based on data from U.S counties. After presenting our analysis, we discuss the complicated issues surrounding specialist supply and population health and the policy implications of our findings. Study Data And MethodsThe period 1996-2000 is the most recent containing the complete set of our chosen study variables for 3,075 counties (99.9 percent of all U.S. counties). We used counties so that we could determine the robustness of prior state-level analyses.Age-adjusted standardized mortality rates are expressed as the number of deaths per 1,000 population. All-cause mortality is among the most commonly used health status indicators, especially in studies on income inequality and health.2 Heart disease and cancer are the two specific leading causes of death. Regarding the definition of specialist versus primary care, physicians engaging in office-

An Aging Population And Growing Disease Burden Will Require ALarge And Specialized Health Care Workforce By 2025

“…[33][34][35] However, there are some indications that the supply of providers in many specialties and locations is inadequate to meet the demand for services. For example, patients often experience long wait times to see a specialist.…”

When one door closes, another door opens: Physician availability and motivations to consult complementary and alternative medicine providers

“…[6][7] Yet little is known about the effect of access difficulties on consumers' health-care choices. The unmet health-care needs that result from physician shortages may not only contribute to greater health risks [8][9] , but can have implications for consumers' health-care attitudes, [10][11] choices, and behaviours 12 . This may be especially true in Canada where unmet health-care needs due to physician shortages have risen substantially over the past decade.…”

Turning Doctors Into Employees

“…10 There is even some U. S. evidence suggesting that an overabundance of specialists can be bad for community health. 11 Yet, despite the demonstrated benefits of primary care, only 35% of U. S. doctors work in it. The majority of our doctors are specialists.…”

“…Medical students quickly learn to M see primary care as bringing low prestige and low pay. 11 There is no particularly good reason why primary care work should be undervalued. The essence of this problem is a political one: specialists run our academic medical centers, have close financial ties to industry, and have been able to define medicine and healing as the use of expensive wonder drugs and high technology.…”