Fixing Health Care: More Doctors Are Not the Solution
Society’s dissatisfaction with the United States health care system will not
be helped by increasing the physician workforce, nor will more doctors lead to
overall better health for Americans, writes Dartmouth Medical School Professor David
Goodman in the Jan. 23 Journal of the
American Medical Association (JAMA).
David Goodman
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Goodman, of the Dartmouth
Institute for Health Policy and Clinical Practice, argues that calls by the
Council on Graduate Medical Education and the Association of American Medical
Colleges for an expansion of up to 30 percent in physician training are a
“distraction” from the real problems of health care access, quality, poor
outcomes, and inefficiencies.
“The inconvenient truth in workforce planning models is that research shows
a weak link between patient outcomes and physicians per capita,” according to
the commentary by Goodman and Kevin Grumbach of the University of California, San Francisco,
School of Medicine. In fact, based on studies of Medicare beneficiaries,
patients living in areas with high physician supply “do not report better
access to physicians or higher satisfaction with care,” the article states.
Currently, there is a 200 percent difference in physician supply across
hospital referral regions. These disparities cannot be explained by patient
populations or patient needs for health care. And the regional differences have
remained nearly constant even when there have been overall increases in the
number of physicians, the authors note. “Over two decades, for every physician
who settled in a low-supply region, four physicians settled in regions with
already high supply.”
Physician workforce distribution is important because previous Dartmouth
research has shown that in many cases, more care is not better for patients.
Yet in areas with a high supply of physicians, patients receive more
treatments, have longer hospitalizations, see more doctors and specialists, and
experience higher use of intensive care.
“These studies should not be misinterpreted to mean that physicians are
unimportant,” write Goodman and Grumbach. “Appropriate medical care can provide
important beneficial effects for patients and populations. But the number of
physicians is just one factor within complex environments that include other
health care workers and the way in which microsystems of care are organized to
deliver care. Higher physician supply per se does not amount to better access,
quality, or outcomes.”
Goodman is professor of pediatrics and of community and family medicine and
associate director of the center for health policy research within the
Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth
Medical School. His work is supported in part by grants from the Robert Wood Johnson Foundation and the National Institute on Aging.
By DEBORAH KIMBELL
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