Authors:

Executive Summary

Physicians are a key component of California's health care system. Their contributions to the diagnosis and treatment of illness are critical to the well-being of the state's population. California's citizens and its policymakers need to know how the state's physicians have responded to the dramatic changes in health care in the United States over the past 25 years. This report, prepared by the Petris Center on Health Care Markets and Consumer Welfare, presents important new findings about long-range trends in physician supply in California, as well as a snapshot of the state's current physician workforce. Most of our data are from the American Medical Association's Masterfile, the most comprehensive and systematic source of data regarding physician practice in the United States. The report addresses vital issues such as whether the state has a sufficient number of physicians, whether physicians are adequately distributed with respect to specialty and geographic location, the extent to which they are meeting the needs of the state's racially/ethnically diverse population, and the growing importance of nurse practitioners and physician assistants.

Full Report [PDF]
Errata [PDF]

Major Findings

We report several new and important findings about the physician workforce in California:

Statewide Trends in the Number of Physicians

• Despite anecdotal reports that the number of physicians in California is declining, the number of active patient care physicians has actually increased by 82% since the late 1970s.
• The statewide physician-to-population ratio has increased by approximately 25% over the past 25 years.
• California's physician-to-population ratio is slightly larger than the average in the rest of the country, but has moved downward towards the national average over the last decade.
• The number of active patient care physicians aged 66 or older has tripled since the late 1970s, and the number aged 56 to 65 has doubled. In contrast, the number of active patient care physicians aged 40 or younger has decreased since the early 1990s. California could face a shortage of physicians in the future unless retirements are offset by an increase in the number of young physicians.

Statewide Trends in the Number of Specialists

• Statewide ratios of active patient care physicians to population have increased since 1978 for generalists, hospital-based specialists, and medical specialists. The ratios of obstetrician/gynecologists and psychiatrists have remained stable. The ratio of surgical specialists to population has decreased over the past 25 years, because the population has grown more rapidly than the number of surgeons.
• During the mid to late 1990s, the incomes of generalist physicians and some specialists decreased, a finding that implies California has abundant supplies of these physicians. In contrast, incomes of psychiatrists, medical specialists, and surgical specialists increased slightly, suggesting that California may have modest shortages of these physicians.

Geographic Distribution of Physicians

• California's physicians are not adequately distributed across the state. Over the past 25 years, some counties have consistently had abundant supplies of physicians, whereas others have had persistent shortages.
• Non-metropolitan counties and counties with low per capita income have low ratios of physicians to population.
• Counties with high Hispanic populations have a low supply of generalist physicians.
• We find no evidence that health maintenance organizations (HMOs) are driving physicians out of California or into retirement.

Racial/Ethnic Distribution of California Physicians

• Although the state's physicians are slowly becoming more racially/ethnically diverse, Blacks and Hispanics remain underrepresented among California's physicians.

Non-Physician Clinicians in California

• The number of nurse practitioners and physician assistants in California has increased rapidly in recent years. These professions complement specialist physicians and substitute for generalist physicians in the delivery of routine primary care. They are especially important resources in areas of California that do not have adequate numbers of physicians.

Policy Recommendations

Our findings suggest the following recommendations for policymakers:

Geographic Distribution of Physicians

• While the evidence does not suggest a need to significantly increase the overall supply of physicians in California, the distribution of physicians in the state would be improved by modestly increasing medical school and residency enrollment for the primary purpose of preparing physicians to meet the needs of underserved populations and communities.
• Policymakers should continue to support policies and programs aimed at increasing access to medical care in communities with an inadequate number of physicians. For example, California could recruit more medical students and medical residents from underserved areas, provide more training in these areas, and expand loan repayment programs for physicians who practice in these areas.
• Expanding health insurance coverage could also help alleviate physician shortages in underserved areas by increasing residents' ability to pay for physician services.

Racial/Ethnic Distribution of California Physicians

• Policymakers should provide more funding for outreach and scholarship programs designed to increase the racial/ethnic diversity of the state's physician medical students and residents.
• Policymakers should ensure that physicians educated in California have the linguistic and cultural competencies required to meet the health care needs of the state's racially/ethnically diverse population.

Non-Physician Clinicians in California

• Finally, policymakers should support alternatives to traditional doctor-patient visits that can improve the efficiency and effectiveness of medical care. Options include expanding the use of physician assistants and nurse practitioners, as well as the use of information technologies, such as the Internet, electronic mail, and telemedicine. These tools may allow the state to maximize the efficiency and effectiveness of medical care.

Research Recommendations

Our findings suggest the following recommendations for future research:

• California policymakers should closely monitor physician supply and the demand for medical care in the state. Two issues that warrant particular attention are the decreasing number of young physicians in the state and the lack of growth in the number of surgical specialists.
• State officials should provide the California Medical Board with sufficient resources to complete periodic surveys of California's licensed physicians. These surveys should encompass demographic information as well as indicators of supply and demand for physicians, such as the number of hours that physicians work and their incomes.
• Policymakers should also fund studies of factors that affect the demand for physicians, such as trends in population demographics, burden of disease, advances in biomedical science, and the financing and delivery of health care services.
• Studies of supply and demand for physicians should assess trends in major physician specialties as well as overall trends so that policymakers can determine whether shortages exist in certain specialties.

[Back To Top]