Doctors, dollars, and determination: making physician work-force policy.

Because managed care is likely to feature prominently in a reformed health care system, policymakers need to examine the impact managed care will have on medical practice, physician supply, and access to primary care providers. Goals for work-force reform should focus on five areas: (1) training physicians in the generalist disciplines of family practice, general internal medicine, and general pediatrics; (2) shaping the physician work force to reflect the nation's ethnic diversity; (3) distributing physicians in a geographically equitable way; (4) maintaining the current physician-to-population ratio rather than letting it continue to grow; and (5) establishing supply needs for nurse practitioners, primary care physician assistants, and certified nurse midwives.