Population Research and Policy Review 19: 477–503, 2000.
© 2000 Kluwer Academic Publishers. Printed in the Netherlands.
Uncertainty and forecasting local health professional shortages
KENNETH D. SMITH, IRMA PEREZ-JOHNSON &
Mathematica Policy Research Inc., Princeton, New Jersey, USA
Abstract. We used a utilization-based scenario-forecasting model to assess the evidence for
current and future imbalances between health professional supply and demand in Memphis-
Shelby County, Tennessee. The scenario-forecasting model, based on qualitative information
collected from local health industry leaders, was shaped and limited by the types of current
local area data available. This paper discusses methods that may prove useful to applied
demographers making forecasts, given uncertain system change and poor data.
Keywords: Delivery of health care, Forecasting, Health manpower, Uncertainty
Rapid changes in medical technology and powerful market forces are re-
shaping the systems that deliver health care services in Memphis and Shelby
County, Tennessee, just as they are throughout the United States. Since its
introduction in 1994, the TennCare managed care program for Tennessee’s
Medicaid and uninsured population has had a great impact on how local
providers conduct their business. Yet TennCare will likely be only one in a
series of changes that affect the region. At this point, all that is known is that
nationwide trends – such as increasing levels of managed care, rapid tech-
nological changes, and an increasing focus on primary care – will continue
to change the local service delivery system. Faced with these changes, local
policymakers and health care industry leaders are having difﬁculty making
the adjustments necessary in the number and type of health professionals
available to meet the community’s present and future needs.
To help local policymakers and industry leaders make these adjustments,
in 1997 the Assisi Foundation of Memphis, Inc., contracted with Mathe-
matica Policy Research, Inc., to conduct the Memphis Healthcare Workforce
Study. The Assisi Foundation wanted concrete answers to speciﬁc questions.
One of these questions was, which, if any, health professions currently have
a shortage or are likely to have a shortage in the future? However, there were
so many changes in the local health care delivery system that we were reluc-
tant to make any conclusions about current shortages based on one standard