CLINTON HEALTH PLAN MAY LIMIT NUMBER OF SPECIALISTS

                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: TUESDAY, March 23, 1993                   TAG: 9303230013
SECTION: NATIONAL/INTERNATIONAL                    PAGE: A-6   EDITION: METRO 
SOURCE: Los Angeles Times
DATELINE: WASHINGTON                                LENGTH: Medium
CLINTON HEALTH PLAN MAY LIMIT NUMBER OF SPECIALISTS
As part of its long-term vision for health-care reform, the Clinton administration may create a set of financial incentives to reverse the nation's lopsided ratio of general practice physicians to specialists, according to knowledgeable sources.
Although final decisions have not yet been made by the health-reform task force headed by first lady Hillary Rodham Clinton, sources said that options under consideration include government-sponsored low-interest loans and bonuses or scholarships to medical students who choose general practice over the currently more lucrative specialties.
In addition, the administration is weighing a plan that would limit the number of specialty residency slots in the nation's teaching hospitals, sources said.
The positions are funded by the federal government through Medicare, which spends about $5 billion a year on them - believed to be the largest federal expenditure for medical education.
Many experts say that they believe that health-care reform will be impossible without relieving the severe shortage of generalists and family doctors, and reducing the surplus of specialists.
The administration's vision of universal coverage and "managed competition" will require more general-practice physicians who can dispense primary care, particularly in underserved areas such as inner cities and rural communities.
Only about a third of all doctors today are generalists. In 1931, 87 percent of the physician work force was made up of family doctors and other general practitioners. By 1949, the number had dropped to 59 percent; by 1961, to 50 percent. By 1962, the balance had begun to shift in the other direction, toward specialists.
Generalists earn about $100,000 a year. In contrast, specialists can draw as much as $220,000, according to the American Academy of Family Physicians.
Members of the health-care work force development group, a working group that is advising the White House health-care reform task force, believe that initially the problem should be addressed at the educational level - in medical schools and residency programs - before doctors actually launch their medical careers, sources said.
Currently, only a sixth of all medical school graduates are choosing to be generalists.
The aim of the proposals under deliberation is to increase to at least 50 percent the number of medical school graduates who complete a training program in family medicine, general internal medicine and general pediatrics and begin a generalist practice, sources said.
The group has suggested that the government add a bonus to Medicare and Medicaid reimbursement for those who practice in these shortage areas, and that the National Health Service Corps earmark scholarships and loans to physicians who agree to serve there, sources said.
Many of the working group's proposals originated with a report released last fall by the Council on Graduate Medical Education, a group created by Congress in 1986 to advise the secretary of health and human services and Congress on ways to improve the physician work force.
The report recommended that a national plan be drafted that would include the creation of national and state commissions to determine local, regional and national physician needs. Under the plan, physician-training positions and funding would be based on the types of doctors needed.

by Archana Subramaniam by CNB