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February 25, 2009

Health Workforce Planning and Medical Student Career Choice

JAMA. 2009;301(8):824-826. doi:10.1001/jama.2009.158

To the Editor: While I agree with Dr Goodman1 on the need for public health workforce planning in light of impending shortages in primary care, I found it interesting that he did not include within the charter greater oversight of physician reimbursement. Other analysts, including Dr Ebell, whose research he references in support of a workforce commission, have noted the need to address disparities in salary by specialty to create a health care workforce that meets the needs of all citizens.2,3 Since even the most lucrative residencies are rarely filled entirely with US graduates, paring the number of available slots for highly competitive specialties may redirect some US seniors to other residencies, but it is unlikely to trickle all the way down to primary care.2 Additionally, workforce planning focused primarily at the graduate medical education level fails to address physician attrition after completion of training. Altering reimbursement for primary care, either relative to other specialties or absolutely, will be necessary to ensure the persistence of primary care practiced by US graduates.