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Books, Journals, New Media
May 26, 2004

Physician Supply

Author Affiliations

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.

JAMA. 2004;291(20):2491. doi:10.1001/jama.291.20.2491-a

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.

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