Physician Supply and the Affordable Care Act

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Elayne J. Heisler
Analyst in Health Services

Anadequate physician supply is important for the effective and efficient deliveryof health care services and, therefore, for population health and the costand quality of health care. Assessments of the adequacy of physiciansupply often focus on three dimensions of the physician population: itssize; its composition (e.g., the mix between primary care and specialtyphysicians); and its geographic distribution. Policies that aim to alterphysician supply generally focus on both current and future supply alongthese three dimensions because physician training is a lengthy process; therefore,changes implemented to alter supply do not have immediate effects.

Each of the three dimensions of physician supply is important for health carespending and for population health because physician clinical decisionsaffect approximately 90% of each health care dollar spent. In addition, asphysicians provide health care services that, with some exceptions, cannotbe provided by non-physicians, the size, composition, and geographic distributionof the physician population affects the amount and type of health care services available.A number of studies have found physician shortages overall, in certainspecialties, and in certain geographic areas. The federal government paysfor physician services, primarily through the Medicare and Medicaidprograms, and supports physician training through a number of programs invarious departments and agencies. Given current investments in physicianservices and the physician workforce, the adequacy of the current andfuture physician supply may be of interest to Congress.

The Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended)may affect the demand for physician services, a major determinant ofphysician supply, because it expands insurance coverage to some of thosepreviously uninsured. The ACA also includes provisions that may affect thesize, composition, and geographic distribution of the physician population by supportingchanges to physician training, compensation, and practice. Specifically,provisions targeting the number of physicians trained and theirproductivity may affect the size of the physician population. Thecomposition of the physician population may be altered by provisions targetingthe supply of primary care providers or specialties in shortage. Provisionsaddressing the diversity of the physician workforce and thoseincentivizing practice in rural or other underserved areas may affect thegeographic distribution of the physician population. Finally, the ACA includesprovisions that provide for data collection and evaluation of the adequacy ofthe workforce in general, and federal workforce programs specifically.Whether and how these provisions will affect physician supply is not yetknown because some of these provisions have not been implemented yet, aretemporary, will not have immediate effects, or rely on discretionaryfunding.

This report examines each dimension of physician supply, separately discussingcurrent (and, where appropriate, future) concerns and relevant changesincluded in the ACA that may affect each dimension. The report thendiscusses workforce planning activities included in the ACA that mayaffect all three dimensions of supply.


Date of Report: January 15, 2013
Number of Pages: 32
Order Number: R42029
Price: $29.95

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