Healthy, Wealthy, or Wise? Issues in American Health Care Policy

By Charles T. Stewart Jr. | Go to book overview

5
The Excess of Physicians and Services

The country can beneficially absorb an unlimited number of individuals trained as physicians.

-- Peter Bourne, special assistant on health issues to President Carter

Most M.D.s will practice for thirty or forty years. Thus, whenever a surplus of M.D.s arises, it is likely to remain uncorrected for a very long time. This long lag of supply behind demand is worsened by increasingly narrow specialization. Major technological changes can at any time make specialist knowledge obsolete and greatly reduce the demand for particular sub- specialties and greatly increase the demand for others. (Note the effect of water fluoridation on the demand for dentists, the development of artificial joints on the demand for orthopedic surgeons.) Whereas there is a growing surplus in many specialties, there is a shortage of primary-care physicians, especially general practitioners and family physicians.

It is not easy for a subspecialist to shift to another specialty, nor is it clear that many specialists, even if retrained, would make good general practitioners. The mind frame is different: from procedural skills to cognitive skills to diagnosis, from dealing with specific organs or tissues to coping with diverse human beings.

Subsidies, whether in agriculture or higher education or anywhere else, result in excess supply, even if there is no matching demand: witness agricultural surpluses. But in health care, subsidies also result in excess demand, so that there is no effective constraint on supply. One hears all the time about the debt burden of new medical graduates; one does not hear that medical education once was, and residencies still are, heavily government

-51-

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Healthy, Wealthy, or Wise? Issues in American Health Care Policy
Table of contents

Table of contents

  • Title Page iii
  • Contents v
  • Preface vii
  • Notes viii
  • 1 - Determinants of Health 1
  • Notes 6
  • 2 - Why Are Costs Out of Control? 7
  • Notes 27
  • 3 - Must Living Standards Decline? 28
  • Notes 38
  • 4 - Health Insurance Raises Demand and Supply 40
  • Notes 49
  • 5 - The Excess of Physicians and Services 51
  • Notes 77
  • 6 - The Medicalization of Health 82
  • Notes 97
  • 7 - Mental Illness 99
  • Notes 119
  • 8 - The Excessive Demand for Medical Care 123
  • Notes 136
  • 9 - Research and Technology 138
  • Notes 161
  • 10 - The Physician as Agent 164
  • Notes 179
  • 11 - Prevention: Environmental and Behavioral Modification 181
  • Notes 210
  • 12 - The Demedicalization of Health Care 213
  • Notes 222
  • 13 - What to Do? 223
  • Notes 250
  • Index 253
  • About the Author 263
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