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February 25, 2009

Health Workforce Planning and Medical Student Career Choice—Reply

JAMA. 2009;301(8):824-826. doi:10.1001/jama.2009.160

In Reply: Drs Rabkin and Cook argue that medical workforce planning is bound to fail without medical financing reform that addresses the perverse incentives of fee-for-service reimbursement. I agree. The evidence is also robust that a greater infusion of public dollars to expand graduate medical education is likely to lead to more fragmented care and higher costs without improvements in access, quality, and outcomes.1-3 Less widely discussed, the additional physician capacity will adversely affect the pace and direction of health care reform. It is hard to imagine a more efficient and coordinated health care delivery system evolving during an era when teaching hospitals greatly expand the training of subspecialists.