Sunshine JH; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1999; 16: 428.
American College of Radiology, Reston, VA 20191, USA.
RESEARCH OBJECTIVE: Widely-publicized scholarly and semigovernmental projections of a major surplus of specialist physicians, plus perceived deterioration of employment opportunities in the two specialties that our organization covers (diagnostic radiology and radiation oncology) led us to undertake a growing, multi-year program of empirical studies. Our objective is to show how empirical studies have demonstrated (i) repeatedly that major additional considerations must be addressed and (ii) why visible surpluses have not materialized, despite careful and thoughtfully made projections forecasting large surpluses. STUDY DESIGN: (1) Projections were made based on major determinants of supply and "needs." (2) To assess the current situation, we surveyed (i) training program directors, (ii) radiology groups regarding the hiring they did, and (iii) each year's graduates. PRINCIPAL FINDINGS: Supply projections assumed, based on the best prior information, a constant number of graduates from training programs each year and that the percentage of radiologists in each age category (60-64 years, 65-69 years, etc.) who remain active (rather than retired) would be constant. Initially, data supported these assumptions, but in the last 2-3 years we have found major cuts in training programs (most conspicuously, by 1/3 in radiation oncology) and increased retirements (almost twice the expected annual number in diagnostic radiology although, puzzlingly, no change in radiology oncology despite a worse employment situation). Similar, progressively unfolding complexities have appeared on the needs side of projections. For example, work performed per radiologist, which early data suggested was fairly constant, apparently (but not certainly) grew rapidly, but we have reason to think this may cease. In appraising the current situation, literal unemployment has proved too small to measure meaningfully, so we now compile detailed data on how many graduates have jobs with possibly undesirable characteristics, and on graduates' actual views of these characteristics. For example, most graduates with part-time work sought that situation so, contrary to common assumptions, it generally is not indicative of underemployment. Thus, we have had to conduct surveys of graduates involving more detail and far more respondents than our initial surveys, which contacted only training program directors. CONCLUSIONS: The present situation can be measured accurately, but only with much more effort than anticipated. Current values of the major variables affecting supply and need can also be measured well. However, because these variables undergo large shifts that cannot be anticipated, useful projections even a few years ahead probably are not feasible. IMPLICATIONS FOR POLICY, DELIVERY, OR PRACTICE: As much as useful projections would be desirable, they probably are not feasible. Similar difficulties most likely characterize many health professions besides the two specialties studied. Thus, forecasts of surplus or shortage in many cases are not possible.
Publication Types:
Keywords:
- Data Collection
- Education, Medical, Graduate
- Employment
- Foreign Medical Graduates
- Internship and Residency
- Physicians
- Radiation Oncology
- Radiology
- Specialism
- Specialties, Medical
- Unemployment
- hsrmtgs
Other ID:
UI: 102193679
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