A new model of workforce projections, based on physician supply and utilization, predicts an impending physician shortage, which the nation cannot afford to ignore. The hypothesis put forward by Cooper and colleagues comes under serious challenge in a set of invited perspectives that follow. We thought that it was important to gather a variety of views because the debate over health care workforce issues has been long neglected and deserves closer scrutiny.

METHODS Data SourcesData relating to the numbers of NPC training programs and graduates and to the current and past numbers of practitioners were obtained from reports and articles published by professional, certifying, and other national organizations. Data relating to training programs in the alternative disciplines were obtained directly from the individual schools and colleges, as previously reported. 3 Published data were supplemented and updated by direct communication with professional organizations and state licensing boards and by information available through their Internet Web sites (Table 1). Data relating to physicians (doctors of medicine and doctors of osteopathy) were drawn from previously published studies. 4,10 DefinitionsThe term advanced practice nurse (APN) refers to NPs, CNMs, CRNAs, and CNSs. Advanced practice nurses who received training as both CNSs and NPs were counted as NPs. Those NPs and CNSs engaged primarily in education or research, in psychiatric and mental health

No abstract

Objective. To assess the relationship between levels of economic development and the supply and utilization of physicians. Data Sources. Data were obtained from the American Medical Association, American Osteopathic Association, Organization for Economic Cooperation and Development (OECD), Bureau of Health Professions, Bureau of Labor Statistics, Bureau of Economic Analysis, Census Bureau, Health Care Financing Administration, and historical sources. Study Design. Economic development, expressed as real per capita gross domestic product (GDP) or personal income, was correlated with per capita health care labor and physician supply within countries and states over periods of time spanning 25-70 years and across countries, states, and metropolitan statistical areas (MSAs) at multiple points in time over periods of up to 30 years. Longitudinal data were analyzed in four complementary ways: (1) simple univariate regressions; (2) regressions in which temporal trends were partialled out; (3) time series comparing percentage differences across segments of time; and (4) a bivariate Granger causality test. Cross-sectional data were assessed at multiple time points by means of univariate regression analyses. Principal Findings. Under each analytic scenario, physician supply correlated with differences in GDP or personal income. Longitudinal correlations were associated with temporal lags of approximately 5 years for health employment and 10 years for changes in physician supply. The magnitude of changes in per capita physician supply in the United States was equivalent to differences of approximately 0.75 percent for each 1.0 percent difference in GDP. The greatest effects of economic expansion were on the medical specialties, whereas the surgical and hospital-based specialties were affected to a lesser degree, and levels of economic expansion had little influence on family/general practice. Conclusions. Economic expansion has a strong, lagged relationship with changes in physician supply. This suggests that economic projections could serve as a gauge for projecting the future utilization of physician services.Key Words. Physician supply, health care expenditures, health care labor force Through much of the twentieth century, planners searched for tools that could aid them in defining the future need for physicians. Lacking better means, most adopted normative standards based on experiences in European 675

Preoperative objective measures of CRS disease show little, if any, correlation with disease-specific QOL measures in surgical candidates. It is likely that CT and endoscopy are measuring a different aspect of CRS disease than the QOL measures. In addition, it is possible that preoperative QOL, either alone or in combination with CT and endoscopy, may prove important in selecting patients most likely to benefit from surgery.