In an editorial in The Washington Post on March 26 ("One Man, One Doctor?"), it was suggested that the country may be facing a surfeit of doctors. In fact, this is probably a spurious issue. While we can surely detect that we have long had a shortage of physicians, we have-because of maldistribution, changing patterns of practice and other factors-no valid criteria for determining how many is enough. The notion of sufficiency has been generated in part by a longstanding effort by organized medicine to maintain a closed market for physician, a strategy now under close scrutiny by the Federal Trade Commission, and also a misapplication of the general premise that if you have a shortage of any commodity and you increase the supply, a point of excess must surely come.
This country can beneficially absorb an unlimited number of individuals educated as physicians, allowing the free-enterprise system and not the government to determine what is enough. We set no arbitary ceilings for lawyers, or plumbers or businessmen. While we can be legitimately concerned about whether taxes should be spent to subsidize medical education, this issue must be clearly separated from any suggestion that we have the knowledge or desire to set a quota for physicians.
There are still six to 10 qualified and motivated applicants for each medical school slot. Whether the aspirations of these students grow from a desire to serve humanity or the lure of a comfortable income is hard to say, but if there were substantially more physicians and the substantially more physicians and the competition to make a living was tougher, it would clearly serve to discourage those medical-school applicants the profession needs least.
The everriding health-care issue in America today is cost. While physicians' fees represent only a portion of the problem, more doctors can only serve to help control inflation in this segment of the economy, notwithstanding the argument that doctors are the main culprits in generating other costs in the system. Few health-care consumers would buy the argument that we have enough physicians.
Even more important is the impact on the quality of health care that Americans receive. Over the years we have tried many inducements to get physicians to work in less attractive settings with underserved populations. Many rural communities, inner cities, prison populations, state mental hospitals and the military continue, despite our best efforts, to be desperately short of doctors. If it had not been for a massive migration of foreign physicians to this country, the lack of care would have been catastrophic. Our system does not allow for us to assign people to work where they do not want to, despite the need. Thus the only hope we have of ever ensuring that these underserved groups get quality health care is by having substantially more doctors than suburban America can sustain. It is also the only way to see that enough medical-school graduates go into the generally less popular specialities, such as public health, dermatology or psychiatry.
The United States differs from many other Western nations is seeing medical education as technical training that prepares the graduate only to practice medicine. We perhaps would do well to adopt the approach that sees medicine, like law, as an important professional background for carrers in many areas. Any real surplus of doctors could easily be absorbed to society's certain benefit outside of the traditional medical-practice role, particularly in public policy-making positions relating to health and social welfare.
The job of the government should not be to limit the professional options of young people by assigning ceilings of dubious validity to the professions, but instead to ensure that all barriers, including financial, to equal opportunity for any qualified student are removed. The marketplace should then determine what is enough, and in the long run applications to medical school will respond accordingly.