Adding more physicians to the American health care system will not improve the quality of health care, according to a report written by Dartmouth Medical School professors David Goodman and Elliot Fisher, published in the New England Journal of Medicine on Apr. 17. Instead, more doctors would create a fragmented, inefficient system and cost the government billions of dollars, Goodman and Fisher wrote.
"What we're hoping is that policy makers will get beyond the simplistic notion that more physicians is always better, and begin to question whether that's a wise application of health care dollars," Goodman said in an interview with The Dartmouth. "The policy towards increasing the training rates of physicians needs to be held under the same scrutiny as any other part of health care."
The Association of American Medical Colleges has called for the expansion of medical schools and increased funding of graduate medical education to prevent a predicted future shortage of physicians, the article states. The number of residency programs available for potential doctors after medical school limits the number of people who can become physicians. The Association recommended the federal government add more doctors to the work force by funding the growth of these residency programs.
Goodman and Fisher argue that the problem is not the lack of doctors, as the Association claims, but the fragmentation of the U.S. health care system and uneven availability of doctors. Doctors per capita can vary by as much as 50 percent in different regions of the country, and most new doctors gravitate towards areas with high concentrations of physicians, according to Goodman and Fisher.
"As the supply of physicians increases, physicians continue to settle where supply is already high," Goodman said. "For every physician that goes to a low supply region, there are four that go to a high supply region."
Health care reform efforts should concentrate on bridging the gap between different regions, Goodman said. Adding more doctors, who will likely practice in areas that already have many doctors, will only make this gap wider, the article said.
Many regions suffer from a shortage of primary care doctors, Goodman said. The number of new doctors who choose to focus on a particular field of medicine is increasing because specialization has many financial benefits, Goodman said. Patients who live in areas with high concentrations of doctors are often referred to several doctors before finding the physician with the right speciality. This is more expensive for the health care system and leads to inefficient patient care, Goodman said. More Medicare beneficiaries complain about their medical care in regions where there are many doctors than in regions where there are few, the article said.
"We already have many regions in the country where health care costs are very high, and patients are not getting better care, they are getting excessive care" Goodman said. "We know that the most effective health care systems in the country are health care systems that have very strong primary care."
Goodman and Fisher estimate that the proposed expansion of medical schools and increases in funding for medical residency programs would cost $5-10 billion per year, approximately one third of the National Institute of Health's budget, Goodman said. This draws money away from other health care initiatives, such as preventative care and increased immunization rates, which have already proved effective, Goodman said.
