Daniel Greenberg's Sept. 20 op-ed column on the doctor glut oversimplified the complexities of the physician supply.

According to the Association of American Medical Colleges, the supply of new physicians coming out of U.S. medical schools has increased by 18.5 percent from 1980 to 1996, from about 15,000 per year to 18,000. However, new residents who are foreign medical graduates have increased from about 6,000 per year to 12,000 during the same period. Most of these physicians remain in the country after training.

Moreover, osteopathic medical schools have increased their output from 1,500 per year to more than 2,000 since 1990. If there is a doctor oversupply, both foreign medical graduates and osteopaths must be considered part of the problem.

In the past two decades, the U.S. population has increased from 227 million to 274 million, an increase of 21 percent. The increase in U.S. medical school graduates in practice almost exactly parallels that increase, while foreign medical graduates have doubled. On the demand front, advances in technology have increased the demand for many medical services and have driven the trend toward more specialists.

Managed care and the growth of health care conglomerates also have wrought changes in the way health care is delivered. The problem of access to a physician has grown, as 1 million Americans each year lose their job-related health insurance. Moreover, problems of funding for academic medical centers have become acute following the Balanced Budget Amendment of 1997, which drastically cut funding.

The problem may not be so much a nationwide oversupply as a maldistribution. While Georgetown may be oversupplied with neurologists and psychiatrists, these specialists are in short supply in inner-city Washington and rural Kansas. And most analysts see a shortage of primary care physicians throughout the country.

Cutting back on medical school admissions alone will not solve the physician-supply problem.


Hutchinson, Kans.

The writer is a medical doctor.

The Sept. 20 op-ed piece by Daniel Greenberg bemoaned the fact that the National Institutes of Health (NIH) is "pouring money into ramshackle laboratories." Mr. Greenberg implied that the volume of biomedical research at NIH should not increase because many of our nation's research facilities at universities and medical schools, which receive the bulk of NIH funding, need renovation and repair.

The solution is to modernize these labs. Last year Congress appropriated $30 million for extramural construction at the NIH; only $20 million was provided in 1998. These investments in our research infrastructure are inadequate.

A recent study by the National Science Foundation found that academic institutions have deferred nearly $11.4 billion in repair, renovation and construction projects because of a lack of funds. Almost one-quarter of all research space needs major renovation or replacement. And 70 percent of our medical schools have inadequate space in which to perform biomedical research.

I have introduced the "21st Century Research Laboratories Act of 1999," which seeks to expand federal funding for extramural research construction at the NIH by increasing the authorization to $250 million in 2000 and to $500 million in future years. The bill has bipartisan cosponsorship.

Congress must make research infrastructure as high a priority as research to prevent disease and find cures.


U.S. Senator (D-Iowa)