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