California's medical schools and residency programs must reduce the number of specialists currently trained by at least 25 percent in order to match the state's changing need for doctors, according to a new UCSF report released yesterday.

Titled "California Needs Better Medicine: Too Many Specialists, Too Little Diversity, Poor Distribution," the report reviews trends in medical training in light of current and future requirements, and outlines steps the state's medical schools and residency programs can take to address the imbalance between physician supply and demand. Researchers from the UCSF Center for the Health Professions , in conjunction with the California Primary Care Consortium, released the report during the Consortium's annual meeting yesterday.

"For more than 15 years, health care experts have sounded an alarm about the impending oversupply of physicians, particularly specialists,"
says lead author Janet Coffman, MPP, associate director of workforce policy and analysis at the UCSF Center for the Health Professions.

"Medical schools and residency programs have been slow to respond to these warnings, and now many parts of the state have a serious over-supply of specialists."

Federal and state governments spend significant public dollars to educate and train physicians who are not necessary, according to co-author Kevin Grumbach, MD, director of research for the UCSF Center.

"A glut of specialist physicians has contributed to the high costs of health care," he says. "California is now over-saturated with specialists. It just doesn't make sense to invest 10 or more years of medical education to train a specialist who is not needed and who will not be able to find work in the state."

By the year 2010, the state will have 37 percent more physicians than necessary if the population growth rate continues to slow, according to the report. Other findings include:

• Physicians are poorly distributed across the state. The Bay Area, Central Coast, Los Angeles and Orange County have excess supplies of physicians, while the Central Valley/Sierra, Inland Empire and South Valley/Sierra have shortages. The Bay Area has the highest ratio of physicians to population, twice that of South Valley/Sierra.

• California has 20 to 48 percent more specialists than it requires. Six regions are oversupplied--the Bay Area, Central Coast, Los Angeles, North Valley/Sierra, Orange County, and San Diego/Imperial. Three regions are undersupplied--Central Valley/Sierra, Inland Empire, and South Valley/Sierra. The Bay Area has the highest concentration of specialists, with an excess supply of 50 to 85 percent.

• Latinos and African Americans are underrepresented among the state's physicians. In California, Latinos comprise 26 percent of the population but only 4 percent of physicians, and African Americans are 7 percent of the population but only 3 percent of physicians.

To prevent further physician oversupply in California, the report urges medical schools and residency programs to take immediate action, including:

• Reduce the number of specialist residency positions by at least 25 percent

• Freeze medical school enrollment at the current level

• Maintain current efforts to encourage medical students to pursue generalist careers

• Maintain the number of generalist positions at the current level, and provide adequate resources to support these positions

• Expand opportunities for medical education in underserved areas

• Increase enrollment of underrepresented minorities in medical schools and residency programs

Other co-authors of the UCSF report are John Q. Young and Noelle Blick, staff researchers for the UCSF Center for the Health Professions, and Karen Vranizan, MS, from the UCSF Primary Care Research Center.

The UCSF Center for the Health Professions seeks to assist health care professionals, health profession schools, care delivery organizations, and public policy-makers respond to the challenges of educating and managing a health care workforce capable of improving the health and well- being of people and their communities.

For more information on the report, call 476-8181, or check the Center’s website.

By Rebecca Higbee

1st appeared 5/15/97