Will competition change the physician workforce? Early signals from the market.

Many policymakers and researchers agree that there are problems of physician oversupply and imbalance in specialty mix. Some have argued that these will be resolved as a more competitive health care market develops, predicting that cost-conscious integrated systems will change demands for physician's services. As a result, physicians will experience unemployment or lower incomes, sending a signal to students and educators to change behavior. Although anecdotes abound, there has been no systematic assessment of what changes in the organization and financing of health care are actually doing to the physician labor market. This article considers potential indicators of changes and reviews what these indicators are now showing. Two types of change are assessed: whether increasing demand for generalists is changing specialty mix, and whether the market is creating incentives to train fewer physicians overall. There have been some changes in the market, but it is still too early to know whether they signal a departure from previous trends. Positions in generalist fields are becoming somewhat more attractive, but changes in incomes have been modest and the number of specialists continues to increase. There is also little indication that job opportunities for physicians are contracting.