Fixing Health Care: More Doctors Are Not the Solution
January 22, 2008
Goodman, of the Dartmouth Institute for Health Policy and Clinical Practice and a physician with Dartmouth-Hitchcock Medical Center, 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 co-author, Kevin Grumbach, M.D. 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. The regional differences have also 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 Institute research has shown that in many cases, more care is not better for patients. 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. However, 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." David Goodman is 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. Kevin Grumbach is Chairman of the Department of Family and Community Medicine at the University of California, San Francisco, and San Francisco General Hospital. For a copy of the commentary entitled "Lack of Evidence That Having More Physicians Leads to Better Health System Performance," e-mail Deborah Kimbell: deborah.kimbell@dartmouth.edu.
Hanover, NH --
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 Dr. David Goodman, M.D., M.S., in the current issue of the Journal of the American Medical Association (JAMA).
For more information contact
Deborah Kimbell at (603) 653-3602.
