For Release: 4pm ET January 22, 2008
Contact: Deborah G. Kimbell 603-653-0877
Fixing Health Care: More Doctors Are Not the Solution
Dr. David Goodman
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 Dartmouth Medical School Professor Dr. David Goodman in the January 23 Journal of the American Medical Association (JAMA).
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 Dr. Kevin Grumbach. 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."
Higher physician supply per se does not amount to better access, quality or outcomes.
—Dr. David Goodman
Physician workforce distribution is important because previous Dartmouth Institute 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. Grumbach is chairman of the family and community medicine at the University of California, San Francisco, and San Francisco General Hospital.
For a copy of the commentary, "Lack of Evidence That Having More Physicians Leads to Better Health System Performance," email deborah.kimbell@dartmouth.edu.
-DMS-
