Kaiser cited as staffing model

The work force debate heats up with a challenge to the generally accepted idea that there will be a physician shortage.

By Myrle Croasdale, AMNews staff. Feb. 23, 2004.

As a general internist for Kaiser Permanente in Aurora, Colo., Pierre Onda, MD, sees 18 to 23 patients a day, five days a week. His patients have no problem getting in to see specialists within Kaiser, and he refers a few cases out of network.

"We have a system in place that allows the physician to actually spend time doing what only a physician can do and less time doing stuff you don't need to be doing," Dr. Onda said.

Kaiser physicians are being touted as an example of efficiency for physicians nationwide by Jonathan Weiner, PhD, deputy director of the Health Services Research and Development Center at Johns Hopkins Bloomberg School of Public Health, Baltimore.

In his study of physician staffing in HMOs, "Prepaid Group Practice Staffing and U.S. Physician Supply: Lessons for Workforce Policy" published online Feb. 4 in Health Affairs, Dr. Weiner joins the debate over physician supply. He suggests that the need for more physicians could be negated if U.S. doctors followed the Kaiser model, which is 30% more efficient than other models of care.

His study found that Kaiser maintains a doctor-to-patient ratio of one to 625, compared with the national rate of one to 437. Dr. Weiner examined eight HMOs. Kaiser made up 93% of the group with its 8 million enrollees.

"What I hope this study does is say, 'Hold on, let's wait a minute before we assume there will be a [physician] shortage,' " Dr. Weiner said.

The theory of an impending shortage gained momentum last fall when the federally appointed Council on Graduate Medical Education predicted a 20% shortfall by 2020. The AMA has appointed a committee to study the issue of work-force policy as well.