Books, Journals, New Media Section Editor: Harriet
S. Meyer, MD, Contributing Editor, JAMA; David H. Morse, MS, University
of Southern California, Norris Medical Library, Journal Review Editor.
We in the United States have periodic bouts of hysteria regarding imminent
disaster due to physician shortage or excess. (The same is true about nursing.)
These concerns usually lead to such changes as expanding medical schools and
training programs, varying numbers of admissions, encouraging foreign graduates
to emigrate here, and even subsidizing foreign medical schools.
Whether long-term shortage or surplus ever exists is difficult to know,
given that there are no standards against which to measure an "appropriate"
supply of physicians or objective population "need" for physician care. The
problem may be one of distribution—geographic or specialty—rather
than number. We have among the world's highest ratios of physicians per population
yet complain of physician shortages and queues for care. A main reason for
such uncertainty is that interactions of supply, demand, and price of medical
services generate few signals indicating greater or lesser demand (or need)
for care to underpin physician expansion or contraction. Insurance insulates
most of us from market effects. In addition, there is little relation among
physician services, patient outcomes, and payment. Physicians are paid based
on process, not outcome; whether the patient gets better or not has essentially
no effect. Economic market forces govern purchase of most goods and services
based on individual value (benefit-cost trade-off among alternatives). But
not medical care—poor consumer knowledge compounds inoperative market
forces. Finally, there is a disconnect between responsibility for physician
workforce recommendations and paying for consequences of these decisions.
Bloom BS. Physician Supply. JAMA. 2004;291(20):2491. doi:10.1001/jama.291.20.2491-a