Physician Shortage and Doctor Income

Today’s New York Times front page trumpets  Shortage of Doctors an Obstacle to Obama Goals.” 


The article recounts the concern that there are not enough primary care physicians to meet our future needs – nothing new there.    There is an alternative point of view – David Goodman and Elliot Fisher of Dartmouth look at variation data and suggest that if we could treat the urban population with the same physician-patient ratio in rural areas, the shortage would vanish. 


Here’s a quote I really enjoyed from today’s Times article:

Dr. Peter J. Mandell, a spokesman for the American Association of Orthopaedic Surgeons, said: “We have no problem with financial incentives for primary care. We do have a problem with doing it in a budget neutral way. If there’s less money for hip and knee replacements, fewer of them will be done for people who need them”



The evidence suggests that lowering prices actually causes an increase in utilization – not a decrease.  So – if there are too few knee and hip replacements, decreasing the price in a fee for service environment might actually help!


Seriously, there is a lot in the news about the high income of bankers and other financial wizards – Paul Krugman  today suggests that they are adding no value at all.  Doctors are clearly providing a valuable service, and should be paid well.  But physician income in the US is very high compared to the rest of the world.  Primary care might look a lot more attractive to some medical students if the income of many specialists wasn’t so high.


Of course, physicians will not accept decreases in their incomes without a substantial political fight.