We compared staffing patterns in primary care specialties in three large health maintenance organizations (HMOs) with the national requirements for physicians in 1990 projected by the Graduate Medical Education National Advisory Committee (GMENAC). The HMOs varied in their use of nonphysician providers, family practice specialists, and subspecialists in internal medicine. Nevertheless, projections based on the average experience of these HMOs suggest that 20 percent fewer primary care physicians for children and 50 percent fewer primary care physicians for adults will be needed to meet national primary care needs in 1990 than projected by the GMENAC. As enrollment in HMOs continues to grow, their impact on national requirements for medical personnel will increase. The variety of staffing patterns found among HMOs operating in highly competitive markets suggests the importance of considering alternative configurations for meeting national requirements for primary care. (N Engl J Med 1986; 314:217–22.), It is widely recognized that the use of resources in health maintenance organizations (HMOs), particularly group practice HMOs, differs from that in traditional fee-for-service medical care. Patients enrolled in HMOs have lower hospitalization rates, and HMOs place a greater emphasis on ambulatory care.
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