Today's edition of the NY Times contains an op-ed regarding a proposal by the American Association of Medical Colleges to increase their enrollment by 30%. The title:
Too many doctors in the house. The author, David Goodman, is a doctor at the Dartmouth med school. The title makes his position fairly clear. He argues that cities with a higher number of doctors per capita don't have better health outcomes and predicts that more doctors will lead to more hospital admissions, more tests, etc.
He's got a very difficult argument to make. Med school enrollment in the US hasn't budged since at least the early 80s, despite the increase in population. The slack in the market gets taken up, to some degree, by US residents who train in overseas med schools and by immigrants. Right away there seems to be a strong case for increasing med school enrollment.
Having said that, if anyone reads the NYT op-ed and this diary, I should take some time to debunk the cost argument (that more doctors will lead to higher costs). Step on into extended if you're interested.
The basic premise, that more doctors will lead to higher costs, stems from the idea of "physician-induced demand", a popular topic in the health care literature for a while. Because patients are not in a position to evaluate what they need, physicians could order unnecessary tests, hospitalizations, etc. to increase their billings. In order for this argument to work, you need an uninformed patient and a compliant insurance company. Right away there are problems.
But suppose physicians can induce demand. There's still no reason to think that adding doctors would increase costs. Or, to be more accurate, there's no reason to think that additional costs would be a bad thing. Consider the city of New York, and suppose 5,000 new doctors decided to move there. All other things equal, would the city residents suddenly decide they had to make additional trips to the doctor?
It's more likely that the physician labor market would behave like most other labor markets: more physicians would lead to lower prices for doctors' services. So I don't blame Dr. Goodman for wanting to keep things as is; I wish there were more barriers to entry for my own field.
A few thousand more doctors a year won't cure many of the problems of our health care system, by any means. It sure wouldn't hurt, though.