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The 103rd Congress failed to adopt a national physician workforce policy, but health planners continue to voice concern that there is a shortage of generalist physicians, particularly in rural areas, and that graduate medical education (GME) programs are training too many ``cost-producing'' specialists. [1-4] To reduce utilization in managed care settings, primary care gatekeepers are encouraged to limit referrals to specialist consultants. [5-6] As a result, the use of neurologists in health maintenance organizations (HMOs) (1.2-2.2 per 100,000 insured lives) is considerably less than the prevalence of neurologists in the United States (3.7-4.2 per 100,000 population). [7,8] If HMO utilization of neurologists serves as a benchmark for the whole country, many neurologists will be unemployed or will have to drastically alter their careers. [5]
Although there may be short-term fiscal advantages in emphasizing primary care, the long-term benefit of reducing the number of neurologists nationally is much less certain. For patients with neurologic disorders, any attempt to reduce neurologic services seems counterintuitive in the face of the estimated $400 billion cost to society of neurologic illness, [9] an aging population, and the increasing likelihood of new and effective treatments.
To address these seemingly conflicting perspectives and goals, a national Physician Workforce Conference in Neurology, chaired by Lewis P. Rowland, MD, and sponsored by the American Academy of Neurology (AAN), convened March 8-9, 1995 in Washington, DC. The last time neurologists met to consider these issues was a decade earlier. [10] Participants heard the perspectives of several national organizations that have recommended reducing the total number of U.S. residency training positions and increasing from 20-30% to 50% the number of generalists trained in the physician workforce. [11-13]
Many participants said that a 50:50 generalist-specialist mix is not a panacea for the deficiencies in our current health system [14]; some favored …
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