POLICY/PHYSICIANS: Too many doctors

Dartmouth worthy David Goodman has an op-ed in the NY Times called Too Many Doctors in the House. It makes the arguments that you all know well, but it does contain this lovely zinger.

The association of medical colleges has argued that increasing the doctor supply overall can remedy regional shortages. But in the past 20 years, as the number of doctors per capita grew by more than 50 percent, according to our measurements, most of the new ones settled in areas where the supply was already above average — places like Florida or New York — rather than in regions that lack doctors, like the rural South. Medical training is an expensive business, and it makes little sense to waste additional public dollars to perpetuate doctors’ preference to live in affluent places. (my emph added)

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  1. The fact is that the taxpayer pays (through Medicare – Graduate Medical Education Funding paid to hospital for all physician residencies) for almost all US trained physicians (all primary and specialty areas, capped by the Balanced Budget Act of 1997). Most states fund the Majority of allopathic (MD) and minority of osteopathic (DO) medical schools (taxpayer funded). In return for this taxpayer funding there are very few “strings” attached to what specialty or where the physician practices.
    I contend that if a physician (or any other trained professional) accepts government (taxpayer) funding for their training, then in return our lawmakers should attach “strings” to such physicians to aleviate the variance in training and location.
    My biggest problem with that proposal is that the US Heath Care system is a Public – Private Hybrid that is disconnected (Hardly a system) and no governmental or private entity has jurisdiction to organize such a solution.

  2. I agree with Pat, it does not take an astronaunt to pilot a Cessna. Most other countries train their doctors with the equivelent of what we here in the US train our nurse practitioners and physician assistants. These highly trained clinicians can provide most of the primary care that is required in this country. Physicians should be trained as specialists and patients referred as needed. Our healthcare care system can not afford to pay professionals for the investment of time that is currently required for a family practice physician. When that level of education has been proven to be “just not necessary” to provide primary care. Everyone…physicians, NP and PAs must know when to consult and refer, but to assume that patients will not receive the same level or better care by NPs and PAs is not only untrue but extremely costly to our countries healthcare system.

  3. It is time we get serious about matching the level of training (and the investment in that training) with need. Board certified family physicians are an expensive resource applied equally to well baby checks and management of a sick diabetic. That simply doesn’t make sense. If we rationalize health professional resources, I suspect Goodman might be right…there are probably too many doctors in the house.