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"Vox clamantis" about more M.D.'s

By Jennifer Durgin

Plenty of things are wrong with the U.S. health-care system, but a lack of doctors is not one of them. So says DMS workforce researcher David Goodman,M.D., a vocal opponent of a plan by the Association of American Medical Colleges (AAMC) to expand U.S. medical school enrollment by 30%. The AAMC argues more doctors are needed to keep pace with the nationis aging population.

Odds: This position couldn't bemore at odds with research by Goodman and his colleagues at the Dartmouth Institute for Health Policy and Clinical Practice. In study after study, they've found that places with more physicians—even twice as many as other places—have no better outcomes or patient satisfaction scores.

"The most serious problems facing our health-care system—accelerating costs, poor quality of care, and the rising ranks of the uninsured—cannot be solved by more doctors," Goodman wrote in a 2006 New York Times op-ed essay. True, some places—rural, poor towns and urban, minority communities—do need more physicians. But young M.D.'s don't settle in those places. "Between 1979 and 1999, ... for every physician who settled in a low-supply region, four physicians settled in regions with already high supply," Goodman wrote in the May 2008 Journal of the American Medical Association (JAMA).

This data from Dartmouth research shows that having 60% more physicians per capita in high-supply regions results in outcomes and satisfaction rates that vary from those of moderate- and low-supply regions by only a few percentage points.

Goodman is also concerned about the costs of building more medical schools (12 new ones are seeking accreditation) and creating more residency positions—the latter largely funded by federal programs like Medicare. The price tag totals $5 billion to $10 billion a year, "depending on the subspecialists trained," Goodman reported in the May 2008 New England Journal of Medicine (NEJM).

Analysis: "The proclamation of an impending shortage occurred . . . rapidly," says Goodman, by a few individuals who "were very loud about it." Now Goodman is the one being loud—not only in the Times, JAMA, and NEJM, but also the British Medical Journal and Health Affairs. He believes his comprehensive analysis is changing the debate "in very substantial ways," he says.

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