The delicate task of workforce determination.

Yogi Berra’s well-known quote is particularly apt when applied to recent attempts to measure the U.S. generalist–specialist medical workforce and to predict future workforce distributions.1–3 Predictions of a physician surplus by the year 2000 have featured in studies conducted in the 1990s on behalf of the Council on Graduate Medical Education (COGME).4 Increased demand for generalists was anticipated both by these studies and on account of a general hubris that included more managed care. Oversupply of specialists was expected. On the other hand, a continued shortage of generalist physicians was predicted. Public policy at state and federal levels adjusted to avert this event and now we are starting to see such research as that of Lurie, Goodman, and Wennberg,5 suggesting reasons to celebrate a policy success—we think. The research reported by Lurie and colleagues is masterful. They developed a sensible model accounting for new, partial, and departing physicians; made their assumptions explicit; adjusted for differences in work patterns that tend to be common in women; provided sensitivity testing; and coped with combined residency programs. Using the model and benchmarking against both need and demand-based physician density standards, they project that the supply of generalists will be 85 per 100,000 people in 2025, or about 1200 patients per generalist physician. The implication is that at current levels of training, the supply of generalists will grow and shortly exceed several accepted standards of need. This is surely a declaration of the success of multiple efforts to reverse decades of decline in U.S. general practice. Any theoretical model draws critics to consider its weaknesses when it is applied to practical questions. Here, one might comment on the limitations of Lurie’s model. It does not accommodate diminishing numbers of medical graduates entering residency programs in the primary care specialties in the past 4 years6—this would move both baseline and the projected slope to more conservative levels. It treats all generalists as if they are interchangeable in the ways they provide health care to the people of America—we know that family physicians are more versatile and distribute more readily into rural, poor, and underserved areas.7 It focuses on women in the medical workforce at the expense of wider generational effects—both young men and women entering the workforce may adopt work patterns previously attributed to women alone, further flattening the model’s predicted slope.