In the United States, although the ratio of total physicians per 100,000 population has increased in the last two decades, this increase can be completely ascribed to a growth in the number of specialty practices. During the same time the number of physicians performing primary medical care, such as general practitioners, internists, and pediatricians, has fallen substantially, and is expected to continue to decrease as older physicians retire in future years 1). This decrease has transferred the load of primary care, that care which is delivered during a patient’s first contact with the health system for an episode of illness, to hospital outpatient departments which now act as the “physician” for a large proportion of the population. In the last two decades, the number of visits to outpatient clinics in the United States has increased fourfold2). If national health insurance is legislated there, it is predicted by many that this demand will skyrocket. In this case, it be the waiting time in clinics, rather than financial consideration, which may be the constraining factor on utilization of health resources. The situations in other nations is similar.
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