Glut or shortage? How many doctors do we need?
This isn’t really about pediatric critical care, but it’s a topic that once again has come up for debate: how many doctors do we need? Do we already have enough? Is the problem mainly one of distribution, both in the sense of having too many specialists and a geographic maldistribution of doctors? A little over a decade ago the received opinion was that we were heading for a doctor glut, and should cut back on the number we trained. Now many predict we will not have enough doctors, especially with the progressive aging of our population. Several states have made plans for expanding the sizes of their medical school classes, and, for the first time in decades, new medical schools are opening. You can read a good discussion of this trend here.
On the other hand, some say the statement that we will be short of doctors is false. For one thing, we already have more doctors now than ever before — in 1950 we had 145 physicians for every 100,000 persons, and now we have 280 per 100,000. By 2020, even without expansion of medical schools, we are projected to have 294 doctors for every 100,000 citizens. The problem, some say, is a maldistribution of doctors and too many specialists. You can read a good summary of that argument here.
A major problem in all these discussions is that we really don’t know what the optimal number of doctors is. There is also vigorous debate over whether many things doctors do could be done, often more cheaply, by others, such as nurse practitioners and physician assistants. There is also the real probability that having more doctors will actually drive up demand for what doctors do, thereby increasing the costs of medical care even higher than they already are.
One thing most people don’t realize is that the federal government is the de facto gatekeeper for the number of new doctors we train because it controls much of the financial support for training of resident physicians, the next step after medical school. So it is residency slots, not medical school class size, that determines things. Currently we have more residency slots than we have medical school graduates — the balance is filled out by residents who went to medical schools in other countries. If we have more domestic graduates there will be less foreign residents, but the total won’t change unless the cap on residency slots is lifted.
What do I think? I think health care is not like other parts of our economy, and trying to use simple market-based reasoning will not work. In many ways, doctors drive the demand for our services. We do things, order things. This means, at least in our present system, having more doctors will stimulate more demand, demand which is in some ways insatiable.
There are many debates around the blogosphere about this complicated issue. You can follow a good discussion of it here.
The fact of the matter is that we have too many physicians, not only specialists, but primary care ones also. Access to see those physicians by the poor and uninsured is a different story. In the eyes of certain organizations that profit from a glut of physicians, there will never be too many. Let´s say the AAFP (American academy of family physicians). there is over 100,000 members which contribute with over 30 million dollars per ear just in membership fees (without including other financial endeavors they are involved in) the top positions in the academy enjoy financial perks and some political power. do you think there will ever be too many physicians in their eyes? of course not! the same is said for pediatrics, internal medicine and all of their subspecialties. The thing is doctors are making more and more money…but not for themselves, but for big organizations, hospitals, big medical groups, etc. In the eyes of these corporate monsters a glut is the most wonderful thing that can happen (more competition, less payment to physicians, more profit!). In a nutshell, a lot of organizations in this country (including pharmaceutical companies) are not going to be happy until physicians are ripping each other apart for a job in the local mall fro 5 dlls an hour. Medicine used to be a respected, noble profession in which only intelligent people with vocation and knowledge used to enter. Now, those days are over, all you need to get into medical school is perseverance and a lot of debt, but no intelligence (very scary scenario in the near future i might say)