Provider Supply Issues

Introduction

I have been asked to consider the issues of provider supply and will explain if there are such issues. I have also explained the likely long-term impact of the influx of IMGs into the healthcare system. Along with all this I have explained the reason for the lack of minority representation in the U.S. health profession such a compelling problem for our health policy makers. A conclusion follows that with my own thoughts and views.

Issues with Provider Supply

While managed care decreases hospital use, it increases the use of physicians. Size and composition of the physician workforce has been troubled since the twenty-first century came about. This includes both health professionals and policymakers in particular because of the transformation of the health care delivery system. For the last fifteen years there has been an over supply of physicians. Most of the over supply is made up of non primary care specialists. On the primary care physician side there has been either a shortage or a relative balance. There was a total of 308,487 active physicians which is a ratio of 151.4 (physicians) per 100,000 people in 1970. According to the National Academy of Sciences (1996), "GMENAC concluded that the nation could expect to have a surplus of physicians in the future (not a shortage) and that the surplus would grow from 70,000 physicians in 1990 to 145,000 by the year 2000. Looked at another way, for the past two decades the U.S. physician supply grew at one and one-half times the rate of growth of the general population. Clearly, by the mid-1990s, the nation was well on its way to surpassing the GMENAC predictions."

The United States of America is a country of immigrants and will probably always be. Complexes and challenges are created for those in the healthcare by the diversity of cultures. A wealth of knowledge of disease and knowledge of cultural belief systems are presented by international medical graduates (IMGs) which do have a significant impact on health and disease. Having this diversity within the healthcare system can improve the care delivery within our multicultural environment. I foresee three challenges with this. I see perceptions being biased in regards to medical students, staff, attending physicians, and patients. Here in America patients would much rather have providers that are of the same gender, race, and culture. This creates a hurdle for the IMGs in such a way that the cultural bias can affect patient-physician relationships. I also see international physicians having a problem with communication skills. Speaking and writing English is easier than communicating it. The problem is that communication between everyone involved is influenced by accents, slang terminology, and street language. Between different cultures humor differs and the medium is language. Communication such as non-verbal communication is another medium that can also obstruct the patient-physician relationship because it is so powerful and sophisticated. The hurdle here for the IMGs is accepting all this. One more I see is professional and social acculturation. Here in the US we have a more "team" learning system compared to the hierarchical system of many countries. This requires from learners and teachers alike to accept the time it takes have patience, and understanding it to ease the transition. The hurdle here for the IMGs is that they are going to have to gain an understanding of undergraduate medical education system, but not only