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UNITED STATES DEPARTM ENT OF LABOR
L. B. SCHWELLENBACH, Secretary
BUREAU OF LABOR STATISTICS
A. F. Hinrichs, Acting Commissioner

+

Postwar O utlook for
Physicians

Bulletin 7S[o. 863

For sale by the Superintendent o f Documents, U. S. Government Printing Office




Washington 25, D. C.

-

Price 10 cents




Letter of Transmittal

U n ited S tates D epar tm ent op L ab o r ,
B u r e a u op L abor S tatistics ,
Washington, D . C

., February 12,

1946 .

The S ecretary op L a b o r :
I have the honor to transmit herewith a report on the employment
outlook for physicians. This is one of a series of occupational studies
prepared in the Bureau’s Occupational Outlook Division for use in
vocational counseling of veterans, young people in schools, and others
considering the choice of an occupation. The present study was
prepared by Judith Grunfel. The Bureau wishes to acknowledge the
helpful comments received in comiection with this study from Dr.
Olin West, Secretary and General Manager of the American Medical
Association, Dr. Paul C. Barton, Executive Director of the Procure­
ment and Assignment Service, and Dr. Antonio Ciocco, Chief of the
Statistical Methods Section, Division of Public Health Methods,
U. S. Public Health Service.
A. F. H inr ich s ,
A cting Commissioner.

Hon.

L.

B.




SCHWELLENBACH,

Secretary o f Labor.
(in )

Contents
Page

Summary_____ ___________________________________________________________
1
Prewar trends____________________________________________________________
2
Growth in number of physicians relative to population______________
2
Rising professional standards and trends in supply of graduates_____
3
Effect of trends in supply of new physicians upon growth of medical
profession____________________________________________
Geographical distribution of physicians________________________________
7
Factors affecting distribution of physicians_____________ ____________
8
Wartime developments affecting postwar outlook________________________
10
Withdrawals of physicians for armed forces___________ _____________
10
Wartime developments in training of physicians____________________
11
Postwar demand and supply of physicians_________________________________
12
Postwar demand_____ ________________________________________ _ —
12
Medical care of veterans_____________________________
Hospital and health-center facilities for civilians__________________
13
Postwar needs of armed forces_________________________
Summary of additional postwar demand__________________________
15
Supply in relation to additional demand________ ___________________
15
Replacement needs_____________________________________
15
Graduations of students______________________________________
16
Summary of additional postwar supply in relation to demand___
17
Incomes in the medical profession___________________________ ____________
19




(IV)

13
15

Bulletin

7s[o. 863 o f the

U nited States Bureau o f Labor Statistics
[Reprinted from the M onthly L abor R eview , December 1945, with additional data]

Postwar Outlook for Physicians
Summ ary

IN VIEW of a prospective demand for medical services well in
excess of the prewar demand, and the wartime attrition of medical
manpower, the postwar outlook for physicians appears promising
nationally, and particularly in the numerous States and rural com­
munities in which the numbers of physicians have fallen considerably
short of the need for medical services and the increase in population.
The long-term rate of increase in the medical labor force has not
kept pace with the increase in population. From 1910 to 1940, there
was a net addition of 13.4 percent to the medical labor force, as com­
pared with a 43.2-percent increase in population. The decrease in
numbers of physicians relative to population is somewhat mitigated
by improvements in means of transportation—of particular impor­
tance in rural areas. The relatively slow growth of the number of
physicians in the 3 decades preceding the war was a reflection of the
fact that a large proportion of new entrants into the profession each
year merely replaced those dying or retiring: The replacement
needs have been affected by the age composition of the medical labor
force. The number of physicians 65 years and over rose from 7.9
percent of the total in 1920 to 10.1 percent in 1930 and to 11.5 per­
cent in 1940.
Over half of all physicians resided in 8 States in 1940. There were
21 States in which, although the population increased between 1920
and 1940, the number bf physicians actually decreased. In 25 States
the number of physicians increased, but in all except 8 the population
increased faster than the number of physicians. In the remaining
2 States the relative decrease in physicians exceeded the decrease in
population. There was' wide disparity in the population-physician
ratio in 1940, ranging from 511 persons per physician in New York
State to 1,635 persons in Mississippi.
Owing to a comparatively smaller increment of new entrants, the
States with a greater number of persons per physician likewise have a
greater proportion of older physicians, whose service capacity is lower.
The major factors which affected the location of physicians before
the war were availability of purchasing power for medical care as
reflected in income levels, the general trend toward urbanization, the
availability of modern hospitals, and the proximity of medical schools.
The war has accentuated the wide variations in the populationphysician ratios among the various States..




(l)

2
The postwar demand for physicians is bound to exceed the prewar
demand, because of the increase in population, programs for medical
care of veterans, the probability of larger armed forces, and the
likelihood that there will be more adequate medical care for the
general population.
The number of physicians will not increase enough within a few
years after the war sufficiently to meet the increased needs for their
services. Deaths of some older physicians, the retirement or reduced
service capacity of others in the oldergroups, and mortality of younger
physicians serving with the armed forces will have offset at least
two-thirds of the gains represented by the new physicians trained in
the decade— even though training was accelerated during the war.
There will be shortages of physicians in some of the specialized
fields particularly. The postwar demand for psychiatrists may con­
siderably exceed the available supply, owing to the mental disturb­
ances induced by modern warfare. Shortages of psychiatrists for
rehabilitation of veterans already discharged are reported even in
the States with large numbers of physicians. A demand for more
physicians with training in obstetrics and pediatrics may arise from
the extension of maternity and child-care facilities. The need for
specialists in industrial medicine is also suggested.
Geographically, postwar needs for physicians appear to be greatest
in those States in which the actual number of physicians declined
during the two decades preceding the war, particularly because of
the high average age of the physicians remaining in those States.
Surveys of incomes of independent practitioners showed that physi­
cians ranked high among the major professions and that their average
net income almost doubled from 1939 to 1943. While about one-third
of active physicians had been withdrawn for the armed forces in 1943,
the total gross income of the remaining civilian physicians rose about
48 percent from 1939 to 1943.1
Prewar Trends
grow th

in

num ber

of

p h y s ic ia n s

r e l a t iv e

to

p o p u l a t io n

The medical profession is the fourth largest among professional
occupations in the United States; only teaching, engineering, and
law claimed more workers in 1940. The 1940 American Medical
Directory listed 175,163 physicians, including nearly 10,000 desig­
nated as “ retired” and “ not in practice.” 2 This indicates that slightly
over 165,163 physicians were active in 1940, which approximates the
census figure of 165,629 physicians and surgeons in 1940.
During the three decades before the war the number of physicians
had increased more slowly than total population. In 1910 there
were 151,132 gainful workers reported as physicians and surgeons,
but this included osteopaths— a group which was not shown separately.
If it may be assumed that the number of osteopaths in 1910 was no
greater than in 1920 (5,030), the number of physicians in 1910 would
have been about 146,000. The increase between 1910 and 1940 in
the number of physicians was therefore about 13.4 percent, as com­
pared with a 43.2-percent increase in population over the same period
1For discussion on earnings of physicians, see p. 19.
8Public Health Reports (Washington), March 3, 1944 (p. 286).




3
Trends in the number of women in the profession may be indicated in
part by the fact that the 7,219 women physicians in 1920 constituted
4.8 percent of the total; by 1940 their number had increased to 7,708,
which was 4.6 percent of the total number of physicians.3
RISING PROFESSIONAL STANDARDS AND TRENDS IN SUPPLY OF GRADUATES

A general trend toward raising the low standards of professional
training and licensure, which prevailed at the beginning of the
century, became most apparent in the medical profession after the
American Medical Association established the Council on Medical
Education and Hospitals in 1904. In its first classification of medical
schools in 1907 the latter reported numerous substandard schools.
The Carnegie report on medical education, published in 1910,
noted that many schools required “ little or nothing more than the
rudiments or the recollection of a common-school education,” and
concluded that a 2-year college training was the minimum basis upon
which modern medicine could be successfully taught.4 From
T able 1.— Num ber o f Accredited M edical Schools, Students, and Graduates in the
United States, 1 90 5 -4 5

1

Number of students *
Year

Number
of schools

Number of graduates
Women

Total

Women

Total
Number

Percent
of total

1905.................................................
1910................................................
1915.................................................
1920............................................... 1921.... ............................................
1922.................................................

160
131
96
85
83
81

26,147
21,526
14,891
13,798
14,466
15,635

1,073
907
592
818
879
989

5,606
4,440
3,536
3,047
3,186
2,529

219
116
92
122
151
154

4.0
2.6
2.6
4.0
4.7
6.1

1923.................................................
1924.................................................
1925.................................................
1926.................................. ..............
1927................................................
1928.................................................

80
79
80
79
80
80

16,960
17,728
18,200
18,840
19,662
20,545

1,030
954
910
935
964
929

3,120
3,562
3,974
3,962
4,035
4,262

214
214
204
212
189
207

69
4.3
5.1
5.4
4.7
4.9

1929— ............................................
1930.................................................
1931..................... .......... ...............
1932.................................. .............
1933.................................................
1934.................................................

76
76
76
76
77
77

20,878
21,597
21,982
22,135
22,466
22,799

925
955
990
955
1,056
1,020

4,446
4,565
4,735
4,936
4,895
5,035

214
204
217
208
214
211

4.8
4.5
4.6
4.2
4.4
4.2

1935.................................................
1936........ _.......................................
•
1937.................................................
1938.................................................
1939.................................................
1940.................................................

77
77
77
77
77
77

22,888
22,564
22,095
21,587
21,302
21,271

1,077
1,133
1,113
1,161
1,144
1,145

5,101
5,183
5,377
5,194
5,089
5,097

207
246
238
237
260
253

4.1
4.7
4.4
4.6
5.1
5.0

1941.................................................
1942.................................................
1943................................................
1944................................................
1944 (second session)......................
1945 (to Juno 30)............................

77
77
76
77
77
77

21,379
22,031
22,631
23,529
24,666
24,028

1,146
1,164
1,150
1,176
1,141
1,352

5,275
5,163
5.223
*5,134
5,169
5,136

280
279
241
239
252
262

5.3
5.4
4.6
4.7
4.9
5.1

i Data are from Journal of the American Medical Association (Chicago), August 13,1921, August 19,1922,
August 18,1923, August 16,1929, August 19,1944, and September 1,1945. Figures relate to schools approved
by AM A Council on Medical Education and Hospitals.
* Includes figures for schools of the basic medical sciences.
* Refers to the academic year between July 1, 1943, and June 30,1944.
3 A full discussion of the outlook for women physicians is presented in U. S. Women’s Bureau Bulletin
203, No. 7: The Outlook for Women in Occupations in the Medical Services: Women Physicians.
3 Carnegie Foundation for the Advancement of Teaching, Bulletin No. 4: Medical Education in the
United States and Canada, by Abraham Flexner (New York, 1910), p. 12.




4
1918 accredited medical schools required premedical training of at
least 2 years of college work, including physics, chemistry, and biology.
At the same time that standards were rising, the number of schools
and enrollments therein were declining. As table 1 indicates, grad­
uations reached their lowest point in 1922, rising gradually thereafter
to a peak in 1937. However, the annual average between 1930 and
1939 (5,011) was lower than the number graduated in 1905.
Opinion varies in the medical profession with respect to the number
of physicians to be trained. The Commission on Medical Educatioi ,
established in 1925 by the Association of American Medieal Colleges
for studying “ the educational principles involved in the training and
licensing of physicians/’ stated in its final report (1932) :5
There are in the United States approximately 156,440 licensed physicians, or
1 to 780 of the population. In European countries the ratio is in the neighbor­
hood of 1 to 1,500. Assuming that 1 to 1,200 would be a correct ratio for this
country, we now have an excess of 25,000 doctors. The recognized medical
schools of the United States are graduating about 5,000 a year. Graduates
from unapproved schools, together with those from Canada and Europe, bring
the annual increment to the medical profession up to 5,400. At this rate the
number of physicians will increase more rapidly than the general population,
so that by 1950 the ratio of physicians to population will be 1 to 750. . . . Owing
to the excessive number of applicants, the medical schools are in a position to
make a selection of the more desirable students, which should be based on char­
acter, personality, intelligence, ability, scholastic achievements.

The former director of that commission, Dr. Willard C. Rappelye,
in hearings before a Senate committee in 1944, expressed the opinion
that the number of physicians available “ is entirely adequate for the
medical needs of peacetime and that there is no justification for any
substantial increase in the output of the medical schools.” 6
Another point of vi€>w was expressed by an editorial in the New
England Journal of Medicine (published by the Massachusetts Medi­
cal Society), March 9, 1939, as follows:
It is sometimes claimed that the medical profession is overcrowded. The
proponent of this claim is usually a member of the medical profession and the
ground for the complaint is that there are many doctors, far too many, who are not
able to make a comfortable living. If one employs in other fields the line of
reasoning which has led to this conclusion, one may well declare that the United
States, not to speak of the earth, is overcrowded. * * *
It has been said that medical schools should decrease their enrollments because
there are too many doctors. If they ought to become smaller, it is not for this
reason. The size of a medical school should be determined primarily by the
number of students who can be educated there at the highest possible level of
quality of education. This, one must remember, is not a fixed level.
From bare statistical comparisons with other countries one might conclude,
as has been done, that the United States has too many doctors per thousand of
population, and also by the same token, too many telephones, too many automo­
biles, too many bathtubs. It is a fact that no one knows how many physicians
there should be in the United States and any arbitrary limitations might prove
to be a serious mistake. Perhaps if there were" better physicians, even more would
be needed to care adequately for the population. Our health is far from perfect

In 1935, the AM A Council on Medical Education issued “ a general
warning against the admission of larger classes than can properly be
accommodated or than can reasonably be expected to satisfy scholastic
standards.” 7
8Journal of American Medical Association, December 24, 1932 (pp. 2206-2208).
•Wartime Health and Education, Hearings before Subcommittee of Senate Committee on Education
and Labor (77th Cong., 2d sess.), on S. Res. 74, part 6 (p. 2135), Washington, 1944.
7Journal of American Medical Association, August 31,1935 (p. 686).




5
Enrollments of freshmen decreased from 6,457 in 1933-34 to 5,791 in
1937-38.8 In reference to the decrease in total enrollments from 22,888
medical students in 1935 to 21,587 in 1938, it was pointed out that
“ classes in subsequent years in many cases will be further reduced.” 9
The trend toward raising premedical training requirements may be
illustrated by the fact that of the 77 schools accredited by the Council
on Medical Education and Hospitals, 45 in 1938-39, and 56 in 1941
required 3 years of college, 6 required a baccalaureate degree prior to
admission to* medical school, 5 admitted students with 3 years of
college work if the baccalaureate degree was conferred in absentia at
the end of the first year of medicine, one required 4 years, and only 9
schools accepted in 1941 the minimum of 2 years of college training.
Actually, of the 5,134 medical graduates between June 1943 and 1944,
4,131, or 80 percent, held a baccalaureate degree.1 Since there were,
0
on the average, two applicants for every position in a first-year medi­
cal class, and in some schools considerably more than this number
there was a “ pressure on all students who want ‘to play safe* to take
more than the minimum premedical requirements whether they are
interested in science or not,” according to James B. Conant, President
of Harvard University.1
1
The rising professional standards are also reflected in the licensure
requirements. Most States require graduation from a reputable
medical school, the passing of a licensing examination before a State
board, and annual registration in the community of practice. In
addition, a hospital internship is required in 21 States, the District
of Columbia, Alaska, Hawaii, and Puerto Rico.1 Those who choose to
2
specialize in some branch of medicine— an increasing proportion—
must also undertake extended postgraduate work. As early as 1933,
the American Medical Association passed a resolution favoring the
creation of examining boards in medical specialties. By 1941 sixteen
boards for the certification of specialists were reported.
The high standards established by the examining boards have
contributed greatly to the admirable achievements of American
physicians and surgeons. On the other hand, Dr. R. L. Wilbur,
addressing the Thirty-Fourth Annual Congress on Medical Education
and Licensure in February 1938, stated:
The greatest danger, both to the public and to the profession, lies in the tendency
of some of the boards [for examination of specialists] to conceive of their function
in terms of a medieval guild, each rigidly to restrict the activities of its own
members and to seek first to promote the welfare, financial and professional,
of its own group. The shortsightedness of such a policy is, of course, apparent.
Unless these boards are broadminded enough to place the public interest ahead
of their own immediate apparent profit, they will serve no useful purpose and
must soon be superseded by some other agency.1
3

Altogether, since the beginning of the century, premedical and
medical training have been lengthened from about 3 or 4 years to
some 8 or 9 years (costing the student at least $6,000), including an
internship year. Notwithstanding such stringent requirements, some
12,000 persons applied annually for admission to approved medical
schools during the thirties, and almost half of them were rejected.
8Journal of American Medical Association, August 26,1939 (p. 770).
•Idem, April 29,1939 (p. 1717).
Journal of American Medical Association, August 19.1944 (p. 1126).
u Idem, April 29,1939 (p. 1656).
ii U. S. Office of Education, Medical Guidance Leaflet No. 6,1941 (p. 3).
i* Journal of American Medical Association, April 23, 1938 (p. 1328).
687487°—46-----2




6
Some of the rejected applicants went abroad to obtain medical educa­
tion; in the decade of the thirties, on the average 290 graduates of
European schools (including American citizens and immigrants from
their native countries) were admitted annually to medical practice in
the United States.
Medical schools not approved by the American Medical Association
added 173 licensed physicians annually on the average during the
five-year period from 1934 to 1938. During the same period 545
graduates of osteopathic schools were licensed in a few States which
admit those graduates to the practice of medicine or surgery.1 During
4
the same decade the annual supply of licensed new entrants from
various sources averaged as follows:
Graduates

From all schools_____ _________________ __________________ 5,584
From approved schools___________________________________ 5, Oil
From unapproved schools________ ^_______________________
173
Graduates from osteopathic schools (licensed as physicians
and surgeons)__________________________________________
110
Graduates from European schools_______________ _________
290

Thus about 90 percent of physicians licensed during the thirties were
graduates of medical schools approved by the American Medical
Association.
As a result of the developments in training and licensing of physi­
cians, the number of new entrants to the profession grew smaller in
relation to the total size of the profession; the number of graduates
per 1,000 registered physicians dropped from 46 in 1906 to 21 in 1923,
rose to 30 during the thirties, and amounted to 28 in 1941-42.
I d view of these trends, and the intense competition for entrance to
medical schools, persons considering medical training should inform
themselves not only as to the minimum premedical requirements of
the schools to which they apply, but also as to the viewpoint of the
schools on the desirable optimum of premedical preparation.
E FFE C T OF

TREN D S IN

SU PPLY OF N EW PH YSICIAN S
M EDICAL PROFESSION

UPON GRO W TH

OF

The long-term trend in graduations relative to available numbers of
physicians has affected the age composition of the practicing physicians.
This in turn has affected the service capacity of the profession and the
rate of deaths and retirements from practice.
Owing to the absolutely and relatively smaller supply of potential
entrants to the profession since 1905, as well as to lengthening of the
average life span, the number of physicians 65 years of age and over,
as shown by census data, constituted 7.9 percent of the total in 1920,
and 10.1 percent in 1930. In 1940 the 18,966 physicians of this age
group were 11.5 percent of the total. This indicates that nearly 12
out of every 100 physicians and surgeons belonged to the age group
referred to usually as the age of retirement or partial activity.
This long-range trend in the age distribution of physicians affected
the service capacity of the available medical labor force at the out­
break of war. The median age of all male physicians was 44.1 years
in 1940— the highest among professional men, except for veterinarians
and clergymen. As “ the average patient load decreases regularly
with advanced age above 45 years,” 1 half of the physicians reported
5
u Journal of American Medical Association, April 29, 1939 (p. 1717)*
i* Public Health Reports, September 3, 1943 (p. 1344)




7
as actively employed in 1940 were therefore approaching the point
beyond which the patient load would be expected to decrease.
The replacement needs caused by death of physicians have become
a major factor affecting medical manpower.
On the average, about 3,800 physicians were lost to the profession
each year from 1923 to 1938, death being the major factor.1 During
6
this 15-year period new entrants to the profession totaled 81,000,1
7
or an average of 5,400 annually, indicating that 70 percent of new
entrants were needed to replace losses to the profession caused by
death and retirement. The net addition to the profession averaged,
therefore, 30 percent of all new entrants between 1923 and 1938.
' Toward the end of the thirties replacement needs caused by death
were increasing. Both for 1936 and for 1938 it was reported that
“ the number removed by death annually approximates 4,000.” 1
8
This indicates that over 70 percent of the new entrants prior to the
outbreak of the war were necessary to make up these losses.
GEOGRAPHICAL DISTRIBUTION OF PHYSICIANS

There are wide disparities among the various parts of the country
in the numbers of physicians relative to population, not only as
between States, but also as between rural and urban areas.
The U. S. Public Health Service study covering the period 1923-38
points out that—
In States with expanding physician totals, the losses from the profession during
the period represented 34 per 100 physicians in 1923; there was no significant
change through migration, and 70 new registrants were located in these States in
1938 for every 100 physicians residing therein in 1923. The median age of physi­
cians in these States was 43 years. At the other extreme, States with net de­
creases in physicians during the interval lost 38 from the profession and in addi­
tion realized a net loss of 3 physicians through migration, but obtained only 31
new registrants for every 100 physicians in 1923. In these States the median age
o f physicians in 1938 was 53 years. These large differences in the recruitment of
young physicians and the resulting contrast in age distributions among the . . .
States suggest that unless methods are devised and employed to promote an
increased acquisition of young physicians in States heretofore showing net losses,
the disparities may become more pronounced in years to come.1
9

The considerably higher median age in States in which losses to the
profession exceeded replacements indicates a considerably higher ratio
of older physicians with lower service capacity in the numerous
States affected by the cumulative deficit of replacements. This
cumulative deficit of younger physicians should be kept in mind in
considering the population-physician ratios in the States in which
numbers of physicians were decreasing.
Census data indicate that in 21 States with increasing population
the number of physicians decreased during the two decades from 1920
to 1940 (table 2). In these21 States, in which the trend in the number
of physicians ran contrary to population trends, the population totaled
more than 37 million in 1940, or over 28 percent of the population
of the United States.
In 25 States and the District of Columbia, the number of physicians
increased between 1920 and 1940, but only in 8 States did the rate of
increase in the number of physicians exceed the rate of growth of the
!• Public Health Reports, March 3,1944 (p. 282).
w Idem, November 20, 1942 (p. 1753).
i* Journal of American Medical Association, April 29, 1939 (p. 1707).
* Public Health Reports, November 20,1942 (p. 1757).
•




8
population. In the remaining 2 States— Montana and North
Dakota— the relative decrease in physicians exceeded that in popula­
tion. Thus in 39 of the 48 States and in the District of Columbia, the
number of people per physician increased between 1920 and 1940. In
one State it remained unchanged, and in 8 States it decreased.
T able 2.— State Populations in Relation to Numbers o f Physicians, 1 9 2 0 -4 0 1
Population per
physician

Percent of
increase in
population,
1920-40

Percent of
increase or
decrease in
number of
physicians,
1920-40

Increase in population, decrease in physicians*
Alabama.......... .........................................................
Arkansas..................................................................
Colorado............. .............. ................ .......................
Georgia............... .......................................................
Idaho....................... .................................................
Indiana...................................... ................................
Iowa......................... ................. ................................

20.6
11.3
19.5
7.9
21.5
17.0
5.6

. -1 7.9
-2 8.9
-7 .3
-2 2.4
-14.0
-9 .3
-1 7.9

1,036
743
530
879
900
685
674

1,523
1,161
684
1,222
1,271
883
867

Kansas................ ............ ......... ................................
Kentucky.................................................................
M aine............................. .................. ......................
Mississippi...... ....................... ...... ...........................
Missouri................................... ......... ........... .............
Nebraska............... ................... ................................
Nevada.......................................................................

1.8
17.8
10.3
22.0
11.2
1.5
42.4

-1 8.7
-17.1
-1 9.2
-1 9.4
-17.4
-1 8.8
-5 .9

696
785
696
1,081
563
667
506

871
1,115
951
1,635
758
834
766

New Hampshire.............................. .........................
Oklahoma................. .......... .................................. .
South Carolina...... ............ ......................................
South Dakota......... .................................................
Tennessee.......... .............. ........................ .............
Vermont.....................................................................
Wyoming....................................................................

10.9
15.2
12.8
1.0
24.7
1.9
29.0

-1 1.7
-15.3
-7 .1
-2 2 .5
-1 5 .4
-1 8.4
-12.7

698
767
1,239
979
723
623
748

876
1,043
1,505
1,276
1,066
778
1,105

Increase in population, increase in physicians:
Arizona_____________________ ____ ____ _________
California..................... .............................................
Connecticut.......- ......... ......................... ..................
Delaware.................................................................
District of Columbia............... ................................
Florida.............................................. ......... ..............
Illinois................................................ .......................

49.4
1,01.6
23.8
19.5
51.5
95.9
21.8

+47.2
+60.9
+44.6
+20.7
+41.6
+43.4
+7.6

877
503
803
811
357
677
604

890
630
688
803
382
925
683

Louisiana......................... .............................. ...........
Maryland..................................................................
Massachusetts...................... .......................... .........
M ichigan................................................................
Minnesota................. ...............................................
New Jersey.............................................................
New Mexico.......................................................... .

31.4
25.6
12.1
43.3
17.0
31.8
47.6

+20.6
+25.1
+18.2
+37.7
+20.0
+68.8
+1.2

924
616
642
821
840
901
854

1,006
619
608
855
819
704
1,245

New York..................................................................
North Carolina............. ..........................................
Ohio....................... ............ : ...................................
Oregon....................................... ........... .................. .
Pennsylvania........................................................ .
Rhode Island.......................................................... .
Texas.............................. ..........................................

29.8
39.6
19.9
39.1
13.5
18.0
37.6

+55.9
+20.8
+12.4
+13.6
+25.3
+2.7

614
1,197
647
631
765
817
765

611
1,383
770
781
765
770
1,025

Utah................................. ..........................................
Virginia..................................................... ................
W ashiugton.. ............... .................................. .........
West Virginia......................... ...... ............................
Wisconsin............................................... .................
United States......................... ....................................

22.5
16.0
28.0
29.9
19.2
24.6

+7.8
+9.6
+5.4
+ .5
+22.5
+14.2

876
962
683
850
947
729

995
1,018
830
1,099
922
798

State

+.8

1920

' 1940

i Source: Census of Population 1920, Occupations; Census of Population 1940, United States Summary;
Vol. Ill, The Labor Force, Parts 3, 4, 5, table 13. Percentages have been computed.

The population-physician ratio ranged from 511 persons per physi­
cian in the State of New York in 1940 to 1,635 persons in Mississippi.
FACTORS AFFECTING DISTRIBUTION OF PHYSICIANS

The relationship between per capita income payments and popula­
tion-physician ratios in various States in 1940 (table 3) indicates that



9
a major factor affecting distribution of physicians is purchasing power
as reflected in income levels. In the four States with the low;est per
capita income— below $300— there were, on the average, 1,456 per­
sons per physician, as compared with an average of 683 persons in
the six States with a per capita income of over $800.
T a b le 3.— P er Capita Incom e and Population-Physician Ratios, b y States, in 1940
Per capita
income pay­
ments 1

State

District of Columbia.
Delaware
New York
Nevada
Connecticut

California__________
New Jersey
Massachusetts
Illinois

Rhode IslandMaryland

Michigan___________
Ohio __________ _
Washington
.. .. . ..

Pennsylvania_______
Wyoming...................
Oregon _
Montana

New Hampshire_____
Indiana___
Colorado. _ _
Vermont _
Wisconsin
Minnesota

__ _

Maine______________

Population
per physi­
cian *

$1,080
896
863
836
827
805

382
$03
511
766
688
630

803
766
726
715
712
649

704
608
683
770
619
855

643
632
628
605
579
674

770
830
765
1,105
781
1,058

546
541
624
521
616
509
509

876
883
684
778
922
819
951

Per capita
income pay­
ments »

State

Population
per physi­
cian 2

Missouri___________

$505
485
480
473
471

758
867
995
890
925

Virginia____________

450
440
433
422
413
398
376

1,018
1,271
834
871
1,025
1,099
1,276

368
357
356
356
317
316

1,256
1,006
1.043
1,245
1,066
1,383

315
308
286
268
252
202

1,222
1,115
1,505
1,523
1,161
1,635

Towa
TTtah
An*7.ona
Florida.

Idaho
Nebraska .... _ _
ITansas_____________
Texas

West Virginia............
South Dakota_______
North Dakota.
Louisiana

Oklahoma__________
New Mexico________

Tennessee
North Carolina

Georgia_____________

TTentncky _ ...
South Carolina ...
Alabama
Arkansas
Mississippi _

_

1Survey of Current Business (U. S. Bureau of Foreign and Domestic Commerce, Washington), August
1944 (p. 14). Per capita income payments are derived by division of total income payments by total popu­
lation excluding armed forces and civilians Outside continental United States. In five States however,
income was transferred from the State of the recipients* employment to the State of residence before com­
putation of per capita income. These States are New York, New Jersey, District of Columbia, Maryland,
and Virginia.
* Census of Population, 1940.

Population-physician ratios are also more favorable in predominantly
urban States than in predominantly rural States with similar per
capita income payments. Studies have revealed “ a striking increase
in the number of physicians practicing in urban centers and a cor­
responding decline in the number engaged in rural practice since the
beginning of this century.” 2 The physician-population ratio in the
0
most-urban States was 1% times that of the most-rural States in 1923
and twice as great in 1938.2
0
Availability of hospital facilities and proximity of medical schools
likewise affect the geographical distribution of physicians. The 18
States in which there were no approved 4-year medical schools up to
July 1945 are, with some exceptions, at a disadvantage as compared
with 5 States which have 26 approved schools with 42 percent of the
entire student enrollment in this country and 44 percent of the
graduates between June 1944 and June 1945.2 Wartime experience
1
with shortages of physicians has aroused an interest in some of the
States without medical schools in the establishment of such schools.
Medical training facilities are also being extended by the conversion
> Public Health Reports, September 11,1942 (p. 1368).
°
^ Journal of American Medical Association, September 1, 1945 (p. 51).

687487— 46------ 3




10
of a few schools of basic medical sciences (giving the first 2 years of
medical-school training) into full 4-year schools.
The extent to which availability of hospitals affects location of
physicians is illustrated by the fact that in 1938 there were only 67
physicians per 100,000 population in counties without general or
allied special hospitals as contrasted with 157 for counties in which
there were 250 hospital beds or more.2 Construction of modem
2
hospital facilities in the numerous areas now lacking them may offer
attraction for considerably more physicians, and persons planning to
enter the profession should bear this in mind.
W artim e Developments Affecting Postwar Outlook
WITHDRAWALS OF PHYSICIANS FOR ARMED FORCES

The war required the placement of 12 million healthy men— that
part of the population normally needing the least medical care—in
the armed forces, where the need for medical care is greater than that
of the general population. To serve these men—less than 10 percent
of the population—40 percent of the Nation’s active practicing
physicians were withdrawn from civilian practice. The other 60
percent— the older physicians and those less physically fit—were left
to take care of 90 percent of the population.
The Army needed 7.2 doctors per thousand servicemen and has
primarily sought those under 45 years of age. At the request of the
medical profession recruitment was to proceed on a voluntary basis
and the Procurement and Assignment Service was organized for this
purpose, with representation of the civilian medical profession.
Although there were 176,000 physicians on the roster of the
American Medical Association before the war, only about 130,000
were available for direct medical care for the Armed Forces and for
civilians, after deduction for those not directly engaged in care of
patients and after adjustment for those 65 years of age and over, who
(according to Dr. Frank H. Lahey, Chairman of the Procurement and
Assignment Service) were considered as 33 percent efficient.2
3
About 60,000 physicians were in the armed forces and the Veterans
Administration in November 1944. The withdrawal of physicians
differed widely among the States, despite the attempts of the Pro­
curement and Assignment Service to make it as equitable as possible.
The prewar ratio of population to effective practitioners was 1,022 to 1.
A wartime general ratio of 1,500 population per effective physician
was adopted by the Procurement and Assignment Service as “ the
minimum below which it would be unsafe to reduce civilian medical
service.” 2 Recruiting quotas were established for the States in
4
proportion to the prewar number of active practitioners weighted
by the ratio of physicians of this category to the State population.
Nevertheless, some States lost more than their quotas of physicians
to the armed forces, while others lost less. Among the States in the
former group, by the end of September 1942, were 16 of the 21 States
in which numbers of physicians had decreased during the previous two
2 Public Health Reports, September 11, 1942 (5.1951).
2
2 Investigation of Manpower Resources. Hearings before Subcommittee of Senate Committee on Educa­
3
tion and Labor (77th Cong., 2d sess.) on S. Res. 291, Part 1 (p. 201), Washington, 1943. See also chapter by
Harold S. Diehl, M . D., in Doctors at War (New York, 1945).
2 Investigation of Manpower Resources. Hearings, op. cit., Part 2 (p. 662).
4




11
decades. For example, Alabama, with 1,523 persons per physician in
1940, exceeded its quota by 94 percent; Mississippi, with a ratio of
1,635 to 1, surpassed its quota by 55 percent. Above-quota with­
drawals also occurred in South Carolina, Kentucky, and other States.
On the other hand, California, Connecticut, Illinois, Massachusetts,
New York, and the District of Columbia, which had the most favor­
able population-physician ratios in 1940, had not met their quotas in
September 1942.
To check this trend, active recruiting was limited to 21 States in
1943, and to 31 cities in 1944.
As a result of this accentuation of the prewar trends toward geo­
graphical maldistribution of the physicians relative to population, by
October 31, 1942, the population-physician ratio exceeded the 1,500to-1 minimum in 29 States, including almost all the States in which
numbers of physicians had decreased between 1920 and 1940. The
long-term downward trend has resulted in a high proportion of older
physicians in those States, and since over half of the practicing physi­
cians under 45 years of age had entered the armed forces at the end
of 1942, the remaining older physicians were forced to take on a
heavier load of patients. As a result, the disproportion between
deaths and new entrants is causing an increasing attrition of civilian
physicians in these States. This indicates that, comparatively, the
highest need and demand for medical services may be found in those
States after the war. In Alabama, for instance, in 1944 over 27
percent of the population resided in counties with more than 3,000
persons per physician, as compared with 12.2 percent in 1940; in
Arizona the corresponding figures were 27.1 percent and none; and
in South Carolina 30.4 percent and 4.5 percent.2 At the end of 1943
5
there were 553 counties with more than 3,000 persons for every active
physician in private practice, 141 counties with more than 5,000, and
20 counties with more than lO^OO.2
6
A survey of the postwar intentions of physicians in the armed
forces showed that disinclination to settle in small communities
continues.2
7
WARTIME DEVELOPMENTS IN TRAINING OF PHYSICIANS

Early in the war it became evident that additional physicians were
needed, but the medical schools were already taking all the students
they could train. “ The number of qualified applicants for medical
schools is about double the number admitted year by year,” stated
Dr. Thomas Parran, Surgeon General of the U. S. Public Health
Service in November 1942.
To meet the situation, a program of accelerated training was under­
taken. The program, adopted by all medical schools except the
Woman’s Medical College, made possible the completion of the usual
4-year training in 3 years, by eliminating summer vacations. Between
July 1, 1942, when accelerated training was initiated in most schools,
and July 1945, four classes were graduated. The number of graduates
during those 3 years was 20,662 as compared with 15,535 graduates
2 Wartime Health and Education. Hearings, op cit., Part 6 (p. 2176).
8
2 Interim Report from Subcommittee on Wartime Health and Education to Senate Committee om
8
Education and Labor, on S. Res. 74, January 1945 (p. 14).
2 Journal of American Medical Association, June 16, 1945 (p. 528).
7




12
from approved medical schools during the 3 preceding years— a 5,127
increase above normal.
In April 1944, the Selective Service abolished occupational defer­
ments of premedical students and of medical students not enrolled in
medical schools by July 1, 1944. With no new assignments to the
premedical Army Specialized Training Program, the Council on
Medical Education and Hospitals estimated that the medical schools
will have to select 75 percent of their 1946 freshmen from among
civilians, and stated:
This is manifestly impossible, and it is probable that entering classes in 1946
will be approximately half filled unless the Enlisted Reserve Corps are reinsti­
tuted or Selective Service regulations changed. . . Should no adjustment be
made to correct the present situation a considerable reduction of graduates after
the war will ensue. Although schools will continue the accelerated program,
they will probably admit classes only once annually instead of every 9 months.
This of itself will reduce the number of graduates from the present annual average
of 7,000 to 5,000. If classes can be only half filled, this number will be reduced
to 2,500 graduates per year. Since 3,300 to 3,500 physicians die each year, there
will result an annual and cumulative deficit of 1,000 doctors a year. . . An un­
known number of war casualties among medical officers will also reduce the
supply of physicians.2
8

A resolution, adopted by the American Medical Association at its
annual session in June 1944, emphasized the imminent danger to
national health and requested immediate action by the President or
Congress. At the same session, another resolution on lifting of sex
discrimination from young women desiring to study medicine was
rejected, on the recommendation of the reference committee which
stated that “ there is no large reservoir of qualified premedical women
from which schools could select substantially increased numbers of
women medical students.” 2 As shown by table 1, the number of
9
women students has not shown any significant increase during the war.
Postwar Dem and and Su pply o f Physicians

The demand for physicians after the war will undoubtedly exceed
that before the war, owing to the needs for medical care of veterans, to
the possible maintenance of a larger military service than in 1940,
to population increase, and to the likelihood that medical care of
civilians will be well above prewar levels. As the war has also affected
the supply of graduates, the postwar outlook depends in the final
analysis on the wartime and immediate postwar supply of new
entrants to the profession relative to replacement needs and to the
additional demand.
POSTWAR DEMAND

In evaluating the outlook for the profession, it is necessary to study
the factors affecting demand for the services of physicians. In this
connection a distinction must be made between the real needs of
people for medical care, and the “ effective demand” for such care.
It was not found possible in this study to estimate the number
of physicians required to meet the real needs of the population, since
there are no authoritatively determined general standards for the
medical care of a population, and since concepts of medical care, as
» Journal of American Medical Association, August 19, 1944 (p. 1111).
» Idem, July 1, 1944 (p. 656).




13
well as techniques, are changing constantly. Besides, a realistic
evaluation of outlook for use in vocational guidance must concern
itself 'with the question of effective demand.
Effective demand for the services of private practitioners is influ­
enced primarily by income levels and the rising standards of medical
care desired by the population. On the other hand, effective demand
for the services of the one out of five physicians who were salaried
employees in 1940—working for such institutions as hospitals, sanitoria, insurance companies, industrial plants, research foundations,
medical schools, business firms, medical cooperatives, public health
clinics, or government agencies—is determined more directly by the
policies and funds of the institutions employing them, and only to
a small extent by general income levels.
M edical Care o f Veterans
%

Complete care, including hospitalization and out-patient treatment
by the Veterans’ Administration, is assured by the Servicemen’s
Readjustment Act for the treatment of conditions incurred or aggra­
vated as the result of military service. The Veterans’ Administration
is also authorized to furnish hospitalization, but not out-patient
treatments, for disabilities which are not service connected, provided
beds are available in its facilities, and provided the patient is unable
to pay for hospitalization.
The Servicemen’s Readjustment Act of 1944, Public Law 346,
authorized appropriations for expansion of the present hospital
facilities of the Veterans’ Administration, which will require additional
physicians. The peak demand for hospitalization is expected to
occur in 1975 and ultimately 275,000 to 302,000 hospital and domi­
ciliary beds will be provided, as compared to 80,570 in operation on
November 30, 1941. The greatest expansion among hospital beds
will be for care of neuropsychiatric patients.3 The Veterans’ Adminis­
0
tration also employs physicians for various types of administrative
work such as rating the extent of disabilities of veterans for purposes
of compensation, and adjudicating claims. A conservative estimate
of the increase between 1940 and 1950 in physicians needed by the
Veterans’ Administration for all purposes is nearly 4,000.3*
1
Hospital and Health-Center Facilities fo r Civilians

To a great extent effective demand for the services of physicians
depends on income levels, as suggested by the data in table 3. Al­
though it is difficult to calculate the amount of the increase in demand
for physicians’ services which would occur if substantially full employ­
ment were achieved, the increase would doubtless be great. Total
income levels under conditions of full employment would be more
3 Health Needs of Veterans. Interim Report from Subcommittee on Wartime Health and Education to
0
Senate Committee on Education and Labor (79th Cong.), Washington, February 1945 (p.8). Wartime
Health and Education. Hearings, op. cit., part 5 (p. 1755).
3 An estimate of 15,000 is suggested by Victor Johnson, secretary of AM A Council on Medical Education
1
and Hospitals, and Fred C. Zapffe, secretary of Association of American Medical Colleges, in a report, The
National Stake in the Imperative Resumption of Training for the Scientific Profession, issued jointly by
the National Research Council (OSP Bulletin No. 22) and the American Council on Education (Higher
Education and National Defense Bulletin No. 84), May 28, 1945. This estimate appears to relate to the
number of physicians needed at the time when about 300,000 hospital beds will be in use— i. e., some years
after 1950.




14
than two-thirds higher than in 1940, according to the U. S. Depart­
ment of Commerce.3
2
In this study no attempt was made to estimate the increase in the
numbers of physicians required to meet the demands of the population
for medical services if full employment were achieved. Instead,
allowance is merely made for the increase in population from 1940 to
1950, on the assumption that the'ratio of the general population to the
number of doctors serving it at the end of the decade would be no
different than at the beginning. To the extent that greater income
may mean increased demand for physicians’ services, the estimates
presented herewith understate the prospective effective demand.
On the other hand, some allowance ought to be made for the trend
toward an extension of public health services. The manpower prob­
lems of the Army and Navy have been much more serious than they
would have been had the Nation’s health been better, according to
Interim Report No. 3 of the Senate Subcommittee on Wartime Health
and Education. About 40 percent of the men of military age were
found to be ineligible for military service because of physical and
mental disabilities.
The health deficiencies of the population, thus strikingly illustrated,
have stimulated considerable public interest in the provision of ade­
quate medical service, according to need, through such means as
privately sponsored programs of financing medical care (including
prepayment plans), and publicly sponsored health programs, involving
such suggestions as insurance under social security, the further develop­
ment of preventive medicine, and the construction of additional
hospitals, health centers, and maternity clinics.
A comprehensive program for extension of medical care is embodied
in the President’s message to Congress of November 19, 1945.3
3
His recommendations include Federal aid for construction of additional
hospitals and health centers within the reach of every community;
expansion of public health, maternal and child health services;
“ facilities that are particularly useful for prevention of disease, mental
as well as physical” ; Federal support of a broad program to strengthen
medical education and research; and finally a system for general pre­
payment of medical costs to assure all Americans ready access to
necessary medical, hospital, and related services. Should this pro­
gram materialize, there will be large increases in the demand for
physicians in hospitals for civilians, in teaching, and in medical
research.
The importance attached to grants to the States for construction of
additional hospitals is reflected in pending bills.3 The manning of
4
additional hospitals to be constructed after the war is estimated to
require 8,300 physicians.3 Postwar planning by various private
5
organizations for extension of medical care through prepayment
schemes also points to an increased demand for physicians after
the war.
a Full Employment Act of 1945. Hearings before Subcommittee of Senate Committee on Banking and
a
Currency (79th Cong., 1st sess.) on S. 380, Part 8 (p. 689).
*3 Congressional Record, November 19,1945.
3 See, for instance, Senate Bills S. 191 and S. 1050.
4
3 Hospital Construction Act. Hearings Before Senate Committee on Education and Labor (79th Cong.,
*
1st sess.) on S. 191, Washington, 1945 (p. 83).




15
Postwar Needs o f Arm ed Forces

If the armed forces should be maintained at higher levels than before
1940, there would be an increased need for physicians because of the
lower ratio of population to physicians maintained in the armed forces.
There are no official estimates of the size of the postwar armed forces
to be maintained, but the number of physicians needed may be sug­
gested by the fact that between 12,000 and 16,000 physicians would
be required to serve 2.5 million men, depending on whether peacetime
or wartime ratios are to be assumed. This implies that about 10,000
to 14,000 more physicians would be needed after than before the war
for the armed forces, if a military establishment of that magnitude may
be assumed.
Summary o f Additional Postwar Demand

The additional postwar demand for physicians arising from medical
care of veterans, expanded armed forces, planned construction of new
hospital facilities for civilians, and population increase may be roughly
estimated as follows for about 1950:
Number of physicians

Total increase, 1940 to 1950, in physicians needed....... .................. 32, 500-36, 500
Veterans’ Administration_____________________________________
4, 000
Expanded peacetime armed forces (assuming 2,500,000)________ 10, 000-14, 000
Medical care for civilians at prewar levels, allowing for growth in
population___________ _____________________ ________________
1 10, 200
Extension of medical care above prewar levels, staffing proposed
new hospitals and health centers for civilians________________
8, 300
i Based on the assumption of a 12.8 million population increase by 1950 (minus an estimated increase of 2
million in the armed forces and of 2 million veterans receiving medical care under the program of the Veter­
ans’ Administration) and of an average of 863 persons per physician according to the 1940 census, with the
physicians 65 years and older adjusted downward by two-thirds.
SU PPLY IN R E LA T IO N TO A D D ITIO N A L DEM AND

In estimating the changes in the medical labor force by 1950 as
compared to that of 1940, it is necessary to take into consideration the
replacement needs caused during the decade by deaths of physicians
as well as such changes in their age distribution as may be indicative
of changes in the numbers in retirement or of lowered service capacity.
Offsetting deaths and retirement is the influx of younger physicians
being graduated from medical school and entering the profession.
An estimate of replacement needs is complicated by the fact that
losses of military physicians from death and disability may con­
siderably exceed those of civilian physicians in the respective age
groups, but the actual numbers of military casualties are unknown.
Also, in estimating the supply of graduates during the decade, another
unknown factor is the effect of the draft of premedical students on
enrollments of freshmen in medical schools in 1945-46 and on gradua­
tions at the end of the decade. The following rough estimates of
supply relative to replacement needs and to additional postwar
demand are therefore subject to considerable limitations.
Replacement Needs

It is assumed in estimating replacement needs caused by death that
mortality and life expectancy for physicians at various ages are not
far different from those for all white males and females.3 The com­
6
m Public

Health Reports, March 3, 1944.




16
puted mortality of physicians between 1940 and 1950 in each age
group and the numbers of physicians who may be expected to survive
by 1950 in the respective age groups are shown in table 4.3
7
T able 4.— Estim ated M ortality o f Physicians, 1 9 4 0 -5 0 , and Survivors in 1950
Physicians reported in 19401
Age group

Number

Mor­
tality
between
1940 and
1950

Physicians expected to
survive in 1950
Age group

Number

All age groups.

165,341

29,783

All age groups.

135,558

20-24 years___
25-34 years___
35-44 years___
45-54 years___
55-64 years___
65-74 years___
75-84 years___

1,869
45,037
39,935
31, 766
27,788
15,677
3,289

47
1,651
2,921
5,014
8,658
8,773
2,719

30-34 years___
35-44 years___
45-54 years..—.
55-64 years___
65-74 years___
75-84 years___
85-94 years___

1,822
43,366
37,014
26,752
19,130
6,904
570

i Not including 260 on public emergency work in 1940 for whom no age data were tabulated by the Census.

Replacement needs caused by deaths between 1940 and 1950 may
well exceed the estimate of about 29,800 arrived at-in the above table,
for it may be assumed that wartime mortality of the overworked older
civilian physicians as well as that of younger military physicians would
exceed the peacetime mortality rates derived from Census life tables.
It will be necessary also to replace those physicians who retire or
whose service capacity is diminished because of age. In setting
quotas for recruitment of physicians, the Procurement and Assign­
ment Service assumed that because of retirement of some, partial
retirement of others, and lowered service capacity of other older
physicians, on the average, three physicians of 65 years and over
were required to serve as many patients as one practitioner in younger
age groups. This, of course, does not imply that the greater experi­
ence of older physicians doeanot enhance the quality of their services;
it attempts to allow only for the amount of their services— the num­
ber of patients seen. If the above computation of surviving physi­
cians were modified to count each physician 65 years or older as per­
forming the equivalent of one-third service (and if we include the
10,000 physicians reported by the American Medical Directory as
retired in 1940 but counted in the total to which the Procurement
and Assignment Service applied the adjustment factor), a loss during
1940-50 of the equivalent of about 38,000 full-service physicians
would be indicated, as the combined result of deaths and the aging
of the profession. Should retirement be accelerated as a result of
long-run social trends or the increased wartime strains on older
physicians, the losses to the profession would exceed this number.
Graduations o f Students

During the war an increase in graduations was made possible by
accelerated training and by deferments of premedical and medical
students from induction into the armed forces, but the change in
the deferment policy affecting premedical students, mentioned above,
may have the ultimate effect of reducing the output of graduates in
1948 and 1949. Graduates from approved medical schools num­
w Mortality rates were computed from U. S. Census Bureau, United States Life Tables 1939 to 1941,
Vital Statistics—Special Reports, Volume 19, No. 4 (p. 31). These rates for white males and females have
been applied to determine the mortality of male and female physicians.




17
bered 15,535 during the 3 academic years 1939-40 to 1941-42.
From July 1942, when the acceleration program started, to June
1945, a total of 20,662 persons was graduated. Thus there was an
increase of 5,127 in the number of graduates as compared with the
previous 3-year period. Referring to this increase in supply of
graduates owing to acceleration of training, however, Dr. Victor John­
son, secretary of the Council on Medical Education and Hospitals of
the American Medical Association, pointed out that “ recent policies
of the national authorities pertaining to premedical students will
more than offset this net gain in the next few years,” 3 and continued:
8
“ From now until at least 1947, medical-school freshmen must be
women, or men who were physically disqualified, under or over the
draft age, or veterans. Because people in these categories are limited
in numbers, those admitted to our medical schools in the next year
or two will be appreciably reduced in numbers or in quality.” It
was pointed out that in 1922 the number of graduates fell to 2,529
as a consequence of reduced wartime freshman enrollments.
During the 6 academic years ending in June 1945, the number of
graduates from approved medical schools totaled 36,197. There were
in addition 18,202 freshmen, sophomores, and juniors enrolled in the
academic year 1944-45. If the numbers of enrollments and graduates
are maintained at wartime levels and if acceleration should be con­
tinued in the 3-year cycle from July 1945 to June 1948:—that is,
even if conditions are most favorable— the total number of graduates
in the decade would be about 60,000. On the other hand, if the de­
cline in numbers of graduates anticipated by Dr. Johnson should
become apparent in the graduating class of June 1949, the number of
graduates during the 10 academic years ending in June 1949 (i. e.,
the academic years 1939-40 to 1948-49) may not surpass 55,000.
Some hundreds of graduating physicians would under normal
circumstances have died during the decade but no estimate can be
made of this number since their exact age composition is not avail­
able and since it is impossible to estimate the casualties among those
in the armed forces. Offsetting these losses will be a small number
of licensed graduates of unapproved medical schools.
Summary o f Additional Postwar Supply in Relation to Demand

In summary, on the basis of conservative assumptions as to the
numbers needed to replace physicians dying or in complete or partial
retirement, it is estimated that the following changes would occur
during the decade in the numbers of physicians available for service:
Estimated losses:
Loss of full-service-equivalent physicians arising from
Number
deaths and ageing of the profession (based on peace­
time mortality rates)________________________________
38, 000
Additional deaths of civilian physicians from wartime
strains.----------------------------- ------------------------------------- Unknown number
Deaths and disability of physicians in armed forces
above normal expectations_____________ _____________ Unknown number
Total losses (minimum)_____________________________
Estimated gains: Increment of graduate physicians_________
Estimated maximum net gain in number of physicians available for service_________________________________ ________
m Journal

of American Medical Association, September 1, 1945 (pp. 39, 41, 50).




38, 000
55, 000-60, 000
17, 000-22, 000

18
The increase in the number of physicians available for service, as
calculated above will fall short of additional demand— estimated at
32,500 to 36,500—by at least 10,500 under the most favorable con­
ditions, and under the conservative estimates above, could fall short
by more than 19,500, as a result of military casualties and additional
deaths of civilian physicians from wartime strains. Despite all the
limitations of any estimate, the postwar shortage of physicians is
bound to assume considerable proportions, resulting from a combi­
nation of long-term trends in the training and age distribution of
physicians, and the effects of the war on demand and supply.
The gravity of such a shortage is increased by the fact that, because
of the age composition of the profession, output of graduate medical
students from accredited schools in the prewar decade exceeded losses
to the profession by not much more than 1,000 each year. At prewar
rates of training it would take a number of years to alleviate the con­
ditions implied by the above estimates.
The extent of shortage of physicians will vary among the different
fields of specialization. Since conditions of modem warfare cause
mental disability, an acute postwar shortage of psychiatrists may be
anticipated. In August 1944 there were only about 3,000 members
in the American Psychiatric Association, which included 90 percent
of the physicians qualified in this field.3 Psychiatrists are stated to
9
be the “ scarcest category of medical specialists, both within the
Army and in civilian life.” 3 Even in New York City, where there
9
is the greatest concentration of psychiatrists in the country, facilities
for the rehabilitation of men rejected or discharged by the armed
forces for neuropsychiatric reasons are reported to be “ far short of
needs.” 4
0
The need for more physicians with training in obstetrics and pedi­
atrics was emphasized by Dr. Martha M. Eliot, of the U. S. Children’s
Bureau, in hearings before the Senate Subcommittee on Wartime
Health and Education.
Thousands of mothers and hundreds of thousands of children go without care
that we know how to give, but are not able to provide because of inadequacy of
facilities, of well-trained physicians, nurses, and other professional workers, and
of administrative personnel . . . There are in the United States about 1,400
certified obstetricians, or 1 to 2,000 registered births. There are about 1,700
certified pediatricians, or 1 to 19,000 children under 15 years. Obviously, these
specialists, cannot handle the actual service to all these patients. Even from
the standpoint of consultation, the number is not sufficient because of the dis­
tribution. Some States have as few as 1 or 2 specialists in the entire State.
Only 3 percent of the pediatricians are in communities of less than 10,000 popu­
lation, yet 60 percent of the children live in communities as small or smaller.
Many more specialists in pediatrics and obstetrics need to be trained and the
general practitioners who see the bulk of mothers and children should have
opportunity for further training in obstetrics and pediatrics.

In view of an urgent need for physicians with additional training
in various specialized fields and in view of a prospective postwar
demand for physicians generally well in excess of the prospective
supply, the postwar outlook for physicians would seem exceptionally
bright.
3 Journal of American Medical Association, August 19,1944 (p. 1104).
®
4 New York City Committee on Mental Hygiene of the State Charities Aid Association, in New York
0
Times, September 22, 1944.




19
Incom es in the M edical Profession

Earnings prospects are of interest to those considering training
for the profession. Money incomes of physicians are influenced
largely by the demand for their services relative to the supply, but
there is wide variation in earnings among individual physicians,
resulting from such factors as the length of professional training
and experience, the field of specialization, the size of community,
and the geographical location.
Information on incomes of physicians is based on voluntary reports
to surveys, and, like all such data, is subject to limitations resulting
from failure of some individuals to report. The findings of the
various surveys as to levels of income differ somewhat, but are not
generally very widely divergent;4 and in any event the findings
1
concerning percentage changes from year to year in any particular
survey should not unduly reflect the biases of selection.
The wide variations in physicians’ incomes may be illustrated by the
findings of a survey by the American Medical Association of incomes
in 1928. 4 About 20 percent of the physicians reporting gave their
2
gross incomes as less than $4,500, about 50 percent reported less than
$7,500, and about 20 percent earned more than $13,500. Specialists
earned, on the average, more than general practitioners, who averaged
a gross income of $7,781.4 Those located in the smallest communi­
3
ties were found to earn less than physicians in larger towns and cities.
The highest average income was found in cities with a population
of 50,000 to 100,000. (That this was true in 1939 also is indicated
by the findings of another survey.4 ) Incomes increase with the
4
length of professional experience, but the peak of average annual
gross income was found in the group with 15 to 19 years in practice,
which illustrates the above-mentioned findings that the average
patient load decreases after 45 years of age.
A survey of incomes in 1929 by the Committee on the Costs of
Medical Care 4 reported a median gross income for private practi­
5
tioners of $7,662. The median in communities of less than 5,000
population was $4,746, as compared to $9,245 in larger communities.
The effects of the depression are reflected in a decline of nearly
38 percent in average gross income of independent practitioners
between 1929 and 1933 (table 5), and the effects of increasing em­
ployment are reflected in an increase of nearly 59 percent in their
average gross income in 1941, as compared with 1933. Net income
dropped by nearly 44 percent and then increased by 71 percent in
the same years.
4 For example, a Department of Commerce survey of incomes in 1939 found an average net income of
1
$4,229 (Survey of Current Business, October 1943), as compared to $4,470 found by another survey in the
same year (Medical Economics, September 1940). On the other hand, the Department of Commerce
reported an average gross income of $8,667 in 1929, as compared to $9,764 reported by a survey by the
American Medical Association for 1928 (Journal of the American Medical Association, May 16, 1931).
The Association, in commenting on the latter figure, pointed out that general practitioners, whose average
incomes were lower than those of specialists, failed to report to the survey in proportion to their numbers
in the profession, and that “ the figures for general practice are underweighted while for each type of special
ractice the amounts are overweighted to varying degrees.” If adjustment were made for this factor, average
icomes would have been somewhat lower.
< Journal of the American Medical Association, May 16,1931.
2
« For more recent data on incomes of general practitioners and of specialists in various fields, see Medical
Economics, October 1945, and January 1946.
4 Physicians’ Incomes, Medical Economics, September 1940.
4
4 Maurice Leven: The Incomes of Physicians. An Economic and Statistical Analysis, Publications of the
8
Committee on the Costs of Medical Care,-No. 24,1932, (p. 106).

S




20
T able 5— Average Annual Incom e o f Physicians in the United States, 192 9 -1 94 1
Year
H fl
W
loan
1931 .................................
1932....................................
1933
1934....................................
1935...................................

Gross in­
come
$8,567
8,173
7,191
5,775
5,368
5,871
6,295

Net income
$5,224
4,870
4.178
3.178
2,948
3,382
3,695

Gross in­
come

Year
193R
1937...................................
1938...................................
1939..................................
1940...................... ..........
1941...................................

Net income

$7,020
7,276
7,053
7,261
7,632
8,524

$4,204
4,285
4,093
4,229
4,441
5,047

1 Data are from Survey of Current Business (U. S. Bureau of Foreign and Domestic Commerce, Wash­
ington), October 1943.

Compared to incomes in other predominantly independent pro­
fessions, earnings of physicians reached the top level in recent years.
Although the average income of independent lawyers exceeded that
of independent physicians in 1929, J.933-37, and 1939, “ in 1941, for the
first time since comparable data became available, the average net
income of physicians exceeded that of private legal practitioners and
thus reached the top position among the three major independent
professions of medicine, law, and dentistry.,, 4 This reversal is ex­
6
plained as being “ the result of a combination of secular influences (a
differential rate of increase in the number of lawyers and physicians),
cyclical factors, and the beginning of a shortage of physicians arising
from war.” 4
7
Incomes of physicians increased further during the war because of
the shortage of civilian physicians. In 1943, according to another
survey 4 based on 5,134 returns, the net income averaged $8,688 as
8
compared to an average of $4,470 found by a survey by the same or­
ganization in 1939. The shift toward higher income levels is reflected
in the fact that in 1939 45 percent of the physicians grossed less
than $5,500 as compared to only 16 percent in that income group in
1943. On the other hand, over half had gross incomes of $11,500 or
more in 1943, as compared to a sixth in 1939, as indicated in the follow­
ing statement.4
9
Gross income of—
$1,500 or moreSS, 500 or more$5,500 or more.
$7,500 or more$9,500 or more _
$11,500 or more
$13,500 or more
$15,500 or more
$17,500 or more
$19,500 or more

Cumulative percent
ms
1989
- 95.6
99. 0
9 4 .0
. 78 . 1
84. 3
_ 5 4 .9
_ 3 7 .2
7 3 .8
. 24. 1
62. 2
. 16.4
5 0 .8
_ 10.9
41. 2
.
7 .0
32. 6
.
4 .8
27. 6
22. 5
.
3 .5

The total gross income of active civilian physicians rose from 994.3
million dollars in 1939 to 1,469.4 million dollars in 1943, when “ the
average physician was in the top 3 percent United States income brack­
et.” 5 Thus, in 1943, when about a third of the active physicians
0
Survey of Current Business (U. S. Bureau of Foreign and Domestic Commerce, Washington) October
1943.
c Idem, May 1944.
« Physicians’ Incomes, in Medical Economics, December 1944 (pp. 43, 44).
< Medical Economics. May 1945 (p. 44). Includes only active civilian nonsalaried physicians (i. e.,
«
those who derived less than 50 percent of their incomes from salaries).
" Idem (p. 47).




21
had been withdrawn to serve the armed forces, the total gross income
of the remaining civilian physicians exceeded that received in 1939
by nearly 48 percent. This reflects the considerable increase in the
patient load of civilian physicians. In view of the likelihood that
for some years after the war the numbers of physicians will fall short
of estimated needs, earnings may continue at levels approaching
those achieved during the war.







Occupational Outlook Publications of the Bureau of
Labor Statistics
This bulletin is one of a series of reports on employment trends and
opportunities in the various occupations and professions, for use in the
vocational guidance of veterans, young people in schools, and others
considering the choice of an occupation. The reports describe the
long-run outlook for employment in each occupation and give infor­
mation on earnings, working conditions, and the training required.
Reports are usually first published in the Monthly Labor Review
(subscription price per year, $3.50) and are reprinted as bulletins.
Both the Monthly Labor Review and the bulletins may be purchased
from the Superintendent of Documents, Washington 25, D. C.
Following is a list of other bulletins in the series, with their prices
and with the dates of the publication of articles in the Monthly Labor
Review:
Employment Opportunities for Diesel-Engine Mechanics. Bulle­
tin No. 813 (1945), price 5 cents. (Monthly Labor Review,
February 1945.)
Occupational Data for Counselors, A Handbook of Census In­
formation Selected for use in Guidance. Bulletin No. 817
(1945), price 10 cents. (Prepared jointly with the U. S. Office
of Education.)
Postwar Employment Prospects for Women in the Hosiery
Industry. Bulletin No. 835 (1945), price 5 cents. (Monthly
Labor Review, M ay 1945.)
Employment Opportunities in Aviation Occupations, Part I—
Postwar Employment Outlook. Bulletin No. 837-1 (1945),
price 10 cents. (Monthly Labor Review, Af)ril and June 1945.)
Employment Opportunities in Aviation Occupations, Part II—
Duties, Qualifications, Earnings, and Working Conditions*
(Not yet available in bulletin form.)
Employment Outlook for Automobile Mechanics. Bulletin
No. 842 (1945), price 10 cents.
Employment Opportunities for Welders, Bulletin No. 844 (1945),
price 10 cents. (Monthly Labor Review, September 1945.)
Employment Opportunities in Foundry Occupations. (Monthly
Labor Review, December 1945; not yet available in bulletin
form.)




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