Physician supply

Physician supply refers to the number of trained physicians working in a health care system or active in the labour market. The supply depends primarily on the number of graduates of medical schools in a country or jurisdiction, but also on the number who continue to practice medicine as a career path and who remain in their country of origin. The number of physicians needed in a given context depends on several different factors, including the demographics and epidemiology of the local population, the numbers and types of other health care practitioners working in the system, as well as the policies and goals in place of the health care system. If more physicians are trained than needed, then supply exceeds demand; if too few physicians are trained and retained, then some people may have difficulty accessing health care services. A physician shortage is a situation in which there are not enough physicians to treat all patients in need of medical care. This can be observed at the level of a given health care facility, a province/state, a country, or worldwide. Physician supply refers to the number of trained physicians working in a health care system or active in the labour market. The supply depends primarily on the number of graduates of medical schools in a country or jurisdiction, but also on the number who continue to practice medicine as a career path and who remain in their country of origin. The number of physicians needed in a given context depends on several different factors, including the demographics and epidemiology of the local population, the numbers and types of other health care practitioners working in the system, as well as the policies and goals in place of the health care system. If more physicians are trained than needed, then supply exceeds demand; if too few physicians are trained and retained, then some people may have difficulty accessing health care services. A physician shortage is a situation in which there are not enough physicians to treat all patients in need of medical care. This can be observed at the level of a given health care facility, a province/state, a country, or worldwide. Globally, the World Health Organization (WHO) estimates a shortage of 4.3 million physicians, nurses and other health workers worldwide, especially in many developing countries. Developing nations often have physician shortages due to limited numbers and capacity of medical schools and because of international migration: physicians can usually earn much more money and enjoy better working conditions in other countries. Many developed countries also report doctor shortages, and this traditionally happened in rural and other underserved areas. Reports as recent as January 2019 show that high growth areas like Phoenix, Arizona are experiencing shortages. Shortages are being discussed in the U.S., Canada, the U.K., Australia, New Zealand, and Germany. Several causes of the current and anticipated shortages have been suggested; however, not everyone agrees that there is a true physician shortage, at least not in the United States. On the KevinMD medical news blog, for example, it has been argued that inefficiencies introduced into the healthcare system, often driven by government initiatives, have reduced the number of patients physicians can see; by forcing physicians to spend much of their time on data entry and public health issues, these initiatives have limited the physicians' time available for direct patient care. Anything that changes the number of available physicians or the demand for their services affects the supply and demand balance. If the number of physicians is decreased, or the demand for their services increases, then an under-supply or shortage can result. If the number of physicians increases, or demand for their services decreases, then an over-supply can result. Substitution factors can significantly affect the production of physician services and the availability of physicians to see more patients. For example, an accountant can replace some of the financial responsibilities for a physician who owns his or her own practice, allowing for more time to treat patients. Disposable supplies can substitute for labor and capital (the time and equipment needed to sterilize instruments). Sound record keeping by physicians can substitute for legal services by avoiding malpractice suits. However, the extent of substitution of physician production is limited by technical and legal factors. Technology cannot replace all skills possessed by physicians, such as surgical skill sets. Legal factors can include only allowing licensed physicians to perform surgeries, but nurses or doctors administering other surgical care. Demand of physicians is also dependent on a country's economic status. Especially in developing nations, health care spending is closely related to growth of their Gross domestic product (GDP). Theoretically, as GDP increases, the health care labor force expands and in turn, physician supply also increases. However, developing countries face additional challenges in retaining competent physicians to higher-income countries such as the United States, Australia, and Canada. Emigration of physicians from lower-income and developing countries contribute to Brain drain, creating issues on maintaining sufficient physician supply. However, higher-income countries can also experience an outflow of physicians who decide to return to their naturalized countries after receiving extensive education and training, without ever benefiting from their gained medical knowledge and skill set. Increasing the number of students enrolled in existing medical schools is one way to address physician shortage, or increasing the number of schools, but other factors may also play a role. Becoming a physician requires either several years of training beyond undergraduate education, or a professional undergraduate degree with a duration longer than that of a typical undergraduate degree. Consequently, physician supply is affected by the number of students eligible for medical training. Students that do not finish earlier levels of education, including high school dropouts and in some places those that leave university without an undergraduate or associate degree, do not qualify for entrance to medical school. The more people that fail to complete the prerequisites, the fewer people become eligible for training as physicians. In most countries, the number of placements for students in medical schools and clinical internships is limited, typically according to the number of teachers and other resources, including the amount of funding provided by governments. In many countries that do not charge tuition payments to prospective physicians, public funding is the only significant limitation on the number of physicians trained. In the United States, the American Medical Association says that federal funding is the most important limitation in the supply of physicians. The high cost of tuition combined with the cost of supporting oneself during medical school discourages some people from enrolling to become a physician. Limited scholarships and financial aid to medical students may exacerbate this problem, while low expected pay for practicing physicians in some countries may convince some that the cost is not appropriate.