A contrary view on the physician shortage question

David Goodman, M.D., and Elliot Fisher, M.D. disagree with the claims that there is a significant current and looming physician shortage (Source: "Physician Workforce Crisis? Wrong Diagnosis, Wrong Prescription," New England Journal of Medicine, April 17, 2008).  In this free online access article, Goodman and Fisher, who are involved with the Dartmouth Atlas project, note that the distribution of physicians varies greatly across the country.  This variation, they argue, makes invalid any universal claim for a physician shortage.

Goodman and Fisher next note that evidence suggests that the presence of more physicians does not translate into better care, better access to care, or better continuity of care.  They claim that having more physicians in an area most strongly correlates with more health care spending.

The authors also disagree with the primary recommendations for addressing a physician shortage.  First, they note that physicians tend to practice where there are other physicians, not in areas with lower supply.  Therefore, producing more supply will not guarantee help for an area with a shortage of physicians.  Second, Goodman and Fisher contend that unrestricted expansion of graduate medical education, under current payment systems, would reinforce a fragmented, specialist-focused system of care.  Finally, they argue that expanding the supply of physicians will be expensive, an expense that will consume limited resources needed for other health reform tasks while not have any real evidence for its value.