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February 25, 2009

Health Workforce Planning and Medical Student Career Choice—Reply

JAMA. 2009;301(8):824-826. doi:10.1001/jama.2009.160

In Reply: Drs Rabkin and Cook argue that medical workforce planning is bound to fail without medical financing reform that addresses the perverse incentives of fee-for-service reimbursement. I agree. The evidence is also robust that a greater infusion of public dollars to expand graduate medical education is likely to lead to more fragmented care and higher costs without improvements in access, quality, and outcomes.13 Less widely discussed, the additional physician capacity will adversely affect the pace and direction of health care reform. It is hard to imagine a more efficient and coordinated health care delivery system evolving during an era when teaching hospitals greatly expand the training of subspecialists.

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