Provocative Questions

The latest issue of The Atlantic (December 2007) magazine has a provocative article by Shannon Brownlee exploring the question of whether or not there is a pressing need to train more doctors in light of some well known demographic trends. The Association of American Medical Colleges (AAMC) for some time has been concerned that there may be a glut of physicians in this country but has now abruptly reversed itself, contending "that we’ll be at least 100,000 doctors short by 2025 unless we hurry up and train more." Brownlee argues that this alarmist prediction is based on two rather weak if not untenable assumptions. Although only available online to subscribers at The Atlantic's website, you can read her critique of these assumptions here. Brownlee also has a book out related to topics broached in the article: Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, 2007. A review of the book is here.

Another new book, this one by Roberta Bivins, looks promising: Alternative Medicine? A History, 2007. A review is here.

Comments

[Frank]

Brownlee says:

"Doctors, in effect, generate some of the demand for their services, so that even when there are large numbers of them per capita, they can keep their appointment books full. There is a growing consensus among health-care analysts that this perverse feature of medical economics is spurring a great deal of unnecessary care."

Citations, please?!

Second "debunking" by Brownlee:

"wealth of data suggests that health care is actually no better (and if anything, worse) in parts of the country, like Manhattan and Los Angeles, where we have very high numbers of doctors and, in particular, very high numbers of specialists."

so perhaps the answer is to train more generalists and geriatricians, right?

Certainly one can argue that there are too many specialists in the U.S. But it is simply untenable to jump from that conclusion to the conclusion that there are too many doctors.

Brownlee needs to read Dean Baker's The Conservative Nanny State, on the AMA in particular.

Finally, check out the top 10 highest paying jobs here:
http://www.forbes.com/2006/05/20/06work_bestpayjobs_slide.html?partner=msnbc

[Patrick S. O'Donnell]

Frank,

Thanks for your comment.

I wonder if some of the citations might be provided in her book. I don't know, just a thought. As to the second point, Brownlee is attempting to undermine a premise (or assumption) of an argument: strictly speaking, therefore, she is not using it as a, or *the*, premise from which she herself argues to the conclusion that there are too many doctors. It does so happen to be the case that she believes there may be enough or too many doctors (and for evidence of this she notes both what the AAMC and the Council on Graduate Medical Education have been saying for the past 15 years), or at least that there is no impending shortage of same, as well as the fact that in some regions where there is a high percentage of doctors per capita, this does not necessarily translate into better care, owing in part to the fact that these are specialists rather than, say, general practitioners (and here she does cite studies). But the reason or reasons invoked in attacking the premise of an argument made for coming to the conclusion that that there is a need to train a lot more doctors does not mean that this (or these) premise(s) is (are) the selfsame premise(s) from which she herself comes to the conclusion that there are enough doctors or that there is no impending shortage. She may very well have other, independent, reasons for coming to that conclusion. I don't see the article as using *that* as the specific premise of her belief that there is a sufficient supply of doctors. Her attempt to undermine the premise, therefore, has a purely negative function: to question a key support for an argument. That does not necessarily mean it thereby at the same time functions in a positive way to support *her* argument (or the conclusion of same). She does seem, at least in this article, to be more concerned about the particular ratio of specialists to general practitioners more than anything else, in light of the fact that an increase in the number of doctors is tending to translate into an increase in more specialists in proportion to general practitioners, and that when this happens, it does not appear to correlate with better health care. I don't think she'd be as troubled about an increase in general practitioners.

In any case, I'd like to read her book to see if a fuller argument is perhaps made there for why she believes we she should be skeptical of the claim that there is a pressing need to train more physicians.