Attempts to apply the laws of supply and demand to healthcare often defy logic. Nowhere is this more apparent than in efforts to come up with the proper number of appropriately trained physicians.
Unfortunately, the education of many physicians and other clinicians did not amply prepare them to operate in today's managed-care environment. Their training focused solely on clinical issues and did not acknowledge limitations on resources.
Furthermore, the nation's medical schools have been reluctant to tackle the question of how to produce a more appropriate balance of specialists and primary-care doctors. And, given their vested interest in maintaining the status quo, they have been slow to respond to the increase in healthcare delivery outside the hospital setting.
The time has come, however, to move forcefully to create a medical education system that's more in sync with the country's healthcare needs. In coming years, the growing influence of the managed-care environment will require greater physician awareness of clinical pathways, coverage limitations and medical economics.
Over the years, numerous organizations have proposed the reform of medical school curriculums, funding and teaching methods. Yet the latest effort undertaken by Congress treats hospitals and medical school deans like farmers. In other words, academic medical centers will get paid for not growing new physicians. Sadly, such voluntary cooperation in reducing the number of doctors will take years, so it's unlikely the plan will produce sufficient changes any time soon.
The government needs to aggressively cut funding for specialties that are overpopulated and find ways to provide financial and other incentives to encourage new physicians to practice in inner-city and rural areas, which, unlike much of the rest of the country, actually need more doctors.
For their part, academic leaders must commit themselves to creating a new kind of medical school-one that starts by identifying the community's health needs and shifting the emphasis of physician training to primary care and prevention. Former Surgeon General C. Everett Koop needs more company in his attempt to spearhead such an endeavor at New Hampshire's Dartmouth College .
Finally, physician executives must exert strong leadership in efforts to offer incentives for providing the most appropriate medical care in the most appropriate setting.