To the Editor.
—The argument by Dr Whitcomb1 that the number of generalist physicians in the United States is adequate is flawed for four reasons.First, it adheres slavishly to the physician-population ratio as an instrument of public policy. I pointed out in 1975 that there was no correlation between the physician-population ratio and the quality of care both cross-nationally and within the United States.2 This ratio also ignores maldistribution between generalists and specialists and by geography. More important, Whitcomb's interpretation comparing generalist physician-population ratios between countries is misleading because it ignores the total number of physicians in the workforce. England is a case in point; while its generalist-population ratio is only 54:100 000, generalists comprise 59% of the physician workforce. In the United States, where the ratio is 69:100 000, generalists comprise only 34% of the workforce.Second, cross-national comparisons of physician workforces are fraught with danger
Petersdorf RG. Projections for the Generalist Physician Workforce. JAMA. 1995;274(23):1833-1834. doi:10.1001/jama.1995.03530230019011