PHYSICIANS FOR THE FUTURE *

The best known effort to assess the nation’s future need for physicians, and also to assess the expansion of the educational programs and facilities necessary to satisfy this need, was reported in 1959 by the Surgeon General’s Consultant Group on Medical Education. After considering the various methods of making these particular determinations, the Consultants concluded that in their opinion, the highest goal we could expect to reach would result from maintaining the then physician-population ratio, and that if this were to happen within the limits of our own resources, our medical and osteopathic s c h d s would have to increase the number of their graduates from a base line of 7,400 in 1959 to 11,OOO in 1975, an increase of 3,600 graduates.’ In interpreting these figures it must not be forgotten that at the beginning of each academic year, because of limitatibns of space and equipment, each medical school can take but a specified number of first-year students. At the beginning of each academic year all first-year places are filled, so that any student who drops out after the start of the year leaves a vacancy that is permanent and as a consequence results in one less physician. The attrition rate between the time a class starts and finishes medical school stands at about 12 per cent.2 Therefore, as a consequence of attrition, if 3,600 additional physicians are to be graduated in 1975 they must come from nearly 4,000 freshmen that started four years before. Thus the real task is the creation of 4,000 new first-year places that must be completed by 1971-not by 1975. Other than to refer to the Surgeon General’s Consultants, I will not attempt to document their estimates except to say that at the time they were made they were generally accepted by most of those who were knowledgeable about the nation’s medical establishment. Subsequent to 1959, differences in the anticipated size of our population, in the way of estimating population, and in the way of counting physicians, may seem to indicate that the Consultants’ estimates of: our future medical manpower needs may have been in error. But since a minimum goal was all that was suggested, I consider the Consultants’ conclusions to be as valid today as they seemed in 1959. The term “physician-population” ratio always enters into discussions of medical manpower. This ratio-the number of physicians per lO0,OOO population-is the usual way of measuring available physician manpower. But it tells nothing of the kinds of physicians that are available, and nothing of what they do, and except as the ratio may go above or below an arbitrary standard, it carries only the vaguest of implications for the adequacy, accessibility, or quality of physician care. The Consultants’ report indicated that in 1959 there were 140.7 physicians (M.D. and D.O.) for every 100,ooO population, and that this ratio as compared with 1949, represented a drop from 143.4.’ In 1964, after a conference called by the Health Resources Advisory Commisttee, it was decided to include all interns and residents, the June medical gradu-