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May 16, 2012

Specialization in Health Care—Reply

Author Affiliations

Author Affiliations: Institute of Health Policy Management and Evaluation (Dr Detsky; adetsky@mtsinai.on.ca) and Faculty of Medicine (Dr Gauthier), University of Toronto, Toronto, Ontario, Canada; and Department of Economics, Stanford University, Stanford, California (Dr Fuchs).

JAMA. 2012;307(19):2025. doi:10.1001/jama.2012.3655

In Reply: All 3 of these letters reinforce the difficulties in determining the right mix of specialization in health care. We agree with Drs Plochg and Klanzinga that the members of the medical profession should play a role, but as we stated in our Viewpoint, they are not the only people in society with a stake in the outcome.

Dr Johns and colleagues suggest that the market is better suited for determining the distribution of training options than the government. We might argue that in the United States, the market has not done that well. And because the government definitely has skin in the game as the largest payer, it certainly should have the right to influence the manpower and reimbursement issues. We agree that financial considerations are not the only factor in career choices but are pretty sure that if primary care physicians incomes went up by 80% and specialist incomes went down to the same degree, it would change the distribution of services provided to patients.

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