During the early 1990s, as policy-makers began to express concern about the size of the physician workforce and its mix of generalist and specialist physicians, a number of national institutions and commissions recommended various strategies to reduce the growth of physician supply and alter the mix of generalists and specialists.

From 1992 to 1997, researchers at the University of Wisconsin-Madison Medical School conducted policy studies using different mathematical models designed to test the effects of these proposals.

Key Findings
Among the key findings reported in the more than 20 articles and papers produced are:

• Achieving a 50/50 mix of generalist and specialist physicians could take 50 years or longer.
• Nurse practitioners and physician assistants are already used extensively as substitutes for medical residents in teaching and other hospitals.
• HMOs use fewer physicians per 100,000 enrollees compared with the ratio of physicians to the total U.S. population.
• Large sustained cuts in the number of first-year residents being trained are needed in order to achieve targeted ratios both for the overall physician supply and for the ratio of generalists to specialists.
• Cutting residency slots currently occupied by international medical graduates alone would not sufficiently curb the growth in U.S. physician supply.
• Improving minority representation in the physician workforce would require huge increases in the numbers of blacks, Hispanics and Native Americans as first year medical residents.

Funding
The Robert Wood Johnson Foundation (RWJF) supported this project through two grants totaling $742,077.