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March 22, 1995

What Is Balance in the Physician Workforce?

Author Affiliations

Brown University Providence, RI
University of Washington School of Medicine Seattle

JAMA. 1995;273(12):915. doi:10.1001/jama.1995.03520360029019

To the Editor.  —A number of organizations, public and private, have called for an increase in the production of primary care physicians to 50% of medical school output.1-4 Others have cast doubt on this goal. Dr Cooper5 claims that production of one-third generalists would be more appropriate. That would essentially maintain the current specialist-generalist distribution.Cooper uses selected data to make several arguments against the "50% solution." First, he states that the size of each specialty should depend on technological advances within the specialty rather than on the population to be served. Actually, there is no direct relationship between specialist numbers and expanding technology; the equation is multifactorial, with income potential, training center needs, and academic value systems among the independent variables. Fully developed, rather than "halfway," technologies frequently reduce workforce needs.6Elsewhere, Cooper states a preference for market-driven solutions over regulation and legislation. Isn't the market

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