The marketplace is moving tentatively to correct for the oversupply of U.S. physicians. In a few specialties where the number of doctors exceeds the number needed, new graduates are having trouble finding jobs.
But it's time for federal policymakers to get serious about revamping Medicare funding for graduate medical education, estimated by the Congressional Budget Office at $6 billion for 1996. If restructuring of the medical-care delivery system is to succeed, nothing will have a bigger impact than efforts to reduce the overall supply of physicians and to encourage more of those who do train to focus on primary care.
Since the first of the year, two separate studies have called for steep reductions in both the number of residency slots and federal funding of graduate medical education.
It's clear there are too many docs-some 684,000 in 1994, according to American Medical Association data, compared with about 308,500 in 1970. And the 70%-30% ratio of specialists vs. generalists is exactly opposite of what is needed.
A Pew Health Professions Commission study went so far as to call for a reduction in medical residency positions through closure of medical schools. At the very least, a freeze on class size in medical schools and a moratorium on opening new medical schools are in order.
Perverse incentives in the funding of medical school graduates can no longer be tolerated. Healthcare requires less-costly professionals who are appropriately prepared for an enterprise that is increasingly focused on wellness rather than sickness.