National Health Work Force Policy

TO THE EDITOR:

The American College of Physicians' position paper [1] on the formation of a national commission to regulate the composition of the physician work force represents socialistic thinking that has historically been shown to be invalid. The paper states that “… current competitive forces should not be allowed to dictate the number and mix of physicians over the long term. Planning is needed on a national basis … .” Central planning is never responsive to market needs, and the world's greatest experiment in central planning toppled in ruin when the Soviet Union disbanded. Such methods designed to correct what is perceived to be an imbalance in the composition of the physician work force would only worsen the current situation.

This point is illustrated by the secondary goals listed for the commission. Improved access to physician services in rural and inner-city areas cannot be achieved by a regulatory body without imposing draconian controls on the area in which a new physician is allowed to enter practice. Admittedly, such measures would go far toward reducing the total number of medical school applicants to a level more acceptable to the authors. Additionally, although the proposed commission is to be “insulated from daily political pressures,” it is also to give special consideration to increasing the numbers of minority and underserved physicians and is to be continually monitored by an unspecified external body, which, in practice, could only be done by the U.S. Congress. A supposedly nonpolitical body (charged with political goals and continually monitored by Congress) with the power to choose who gets into medical schools, where residency positions will be available, how many positions will be available in each specialty, and where physicians can practice after completing training is truly a frightening prospect.

The only effective way to increase the number of primary care physicians is to make primary care more attractive in terms of lifestyle, professional standing, and reimbursement. Similarly, the only effective way to improve access in underserved areas is to make these areas more attractive to physicians by improving the lifestyle and reimbursement in such practice settings. In the end, the “current competitive forces” will provide more benefit at less cost than would a central planning commission.

• Copyright ©2004 by the American College of Physicians