Developing accurate forecasts for physician workforce needs is an extraordinarily difficult task. In 1980 the Graduate Medical Education National Advisory Committee (GMENAC) completed a comprehensive workforce study. Based on estimates of growth of the number of pediatricians, GMENAC predicted a potential excess of 4950 pediatricians by 1990.1 The American Academy of Pediatrics (AAP) studied the report and issued a response in 1981 that questioned many elements in the model.2 However, the Academy was concerned that an excess number of pediatricians would be produced by the 1990s, and a statement published in 1985 and revised in 1987 recommended government and academic policies ensuring the production of pediatricians of the highest quality, but in fewer numbers.3
Subsequent to the 1987 statement, consistent evidence has pointed to shortages of pediatricians rather than the projected surplus in all regions of the country. A 1990 survey of residency program directors provided the strongest empirical evidence to date that the supply of new pediatricians is not meeting the demand.4
In 1990, the Council on Graduate Medical Education (COGME) contracted with the consulting firm of Abt Associates, Inc to reexamine the adequacy of physician workforce supply. The resulting report, commonly referred to as the Abt report, contends there would be an even greater oversupply of peditricians than projected in the 1980 GMENAC report.5 The AAP concerns with this report's methodology and conclusions were strongly voiced to the COGME and in the literature.6,7 Subsequent to the Abt Report, the COGME published a report which emphasizes a growing shortage of practicing generalists (ie, general pediatricians, general internists, and family physicians) and calls for an increase in the percentage of residents who complete a 3-year training program in the generalist specialties.8
Plug the Leak: Align Public Spending With Public Need
