Health care policy that encourages expansion of the subspecialty physician workforce undermines the goals of improving America’s health care system. That was among the points made by Robert Phillips, M.D., M.S.P.H., director of the Robert Graham Center in Washington, and his co-authors in the March 15 Health Affairs Web Exclusive.
In “Adding More Specialists Is Not Likely To Improve Population Health: Is Anybody Listening?” the authors say allowing market forces to determine the number and types of medical specialists harms the quality of Americans’ health care.
Studies: Glut of Subspecialists Could Harm U.S. Health Outcomes
By News Staff
3/18/2005
This story first appeared in the March 18, 2005, AAFP Direct.
The writers point to an accompanying article, “The Effects of Specialist Supply On Populations’ Health: Assessing The Evidence,” by Barbara Starfield, M.D., M.P.H., professor at the Johns Hopkins University School of Public Health, Baltimore, and her colleagues. They cite numerous studies showing “lower mortality rates where there are more primary care physicians.” They add, “Increasing the supply of specialists will not improve the United States’ position in population relative to other industrialized countries, and it is likely to lead to greater disparities in health status and outcomes.”
Phillips, Starfield and their co-authors say a glut of subspecialists fragments medical care and increases both costs and health care disparities.
The conclusions of Starfield and her co-authors “offer pause for the recent rush to declare a coming physician shortage, particularly of specialists,” Phillips and his colleagues write, adding, “Policymakers should pay attention to Starfield and colleagues’ troubling finding that having more specialists is not a good thing, and that primary care is.”
Apparently, they are not doing so. The Council on Graduate Medical Education 16th Report to Congress recommended a 15 percent increase in the number of medical school graduates and a 12.5 percent increase in residency positions. Simultaneously, COGME dropped its recommendation of several years that half of U.S. medical school graduates become generalists. Instead, the COGME report says, the marketplace should determine the ratio of primary care to subspecialty residency slots.
Such recommendations reflect the consumer-demand model, rather than the patient-need model, for predicting physician workforce needs, says Phillips. Thus, health care becomes an “economic engine” running on ability to pay. However, with 45 million uninsured and 80 million underinsured Americans, that economic engine fails to provide many with health care, Phillips continues. Moreover, it perpetuates health care disparities that “needlessly cost the lives of nearly 900,000 African Americans” between 1991 and 2000.
“This conflict suggests that a choice should be made -- do we respond to market demands and use our health care system to stoke our economic engine, or do we aim for better population health?” Phillips and his colleagues ask.
An abstract of Starfield’s article is at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.97v1, and an abstract of Phillips’ commentary is at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.111v1.
Phillips, Starfield and their co-authors say a glut of subspecialists fragments medical care and increases both costs and health care disparities.
The conclusions of Starfield and her co-authors “offer pause for the recent rush to declare a coming physician shortage, particularly of specialists,” Phillips and his colleagues write, adding, “Policymakers should pay attention to Starfield and colleagues’ troubling finding that having more specialists is not a good thing, and that primary care is.”
Apparently, they are not doing so. The Council on Graduate Medical Education 16th Report to Congress recommended a 15 percent increase in the number of medical school graduates and a 12.5 percent increase in residency positions. Simultaneously, COGME dropped its recommendation of several years that half of U.S. medical school graduates become generalists. Instead, the COGME report says, the marketplace should determine the ratio of primary care to subspecialty residency slots.
Such recommendations reflect the consumer-demand model, rather than the patient-need model, for predicting physician workforce needs, says Phillips. Thus, health care becomes an “economic engine” running on ability to pay. However, with 45 million uninsured and 80 million underinsured Americans, that economic engine fails to provide many with health care, Phillips continues. Moreover, it perpetuates health care disparities that “needlessly cost the lives of nearly 900,000 African Americans” between 1991 and 2000.
“This conflict suggests that a choice should be made -- do we respond to market demands and use our health care system to stoke our economic engine, or do we aim for better population health?” Phillips and his colleagues ask.
An abstract of Starfield’s article is at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.97v1, and an abstract of Phillips’ commentary is at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.111v1.
