Politics and Your Practice: Too Many Doctors In The House?

The debate over whether the U.S. has too many physicians reminds me of the joke about the scientist studying the jumping capabilities of bullfrogs.

He sets a bullfrog on a table and says, “Jump, frog, jump.” The frog jumps 10 feet, which the scientist notes in his journal. The scientist then cuts off the bullfrog’s back legs and says, “Jump, frog, jump.” It jumps five feet, which again is noted. The scientist removes its remaining legs. “Jump, frog, jump,” the scientist directs.

This time the frog does not move.

“Frog deaf,” the scientist writes.

Earlier this year, the Association of American Medical Colleges (AAMC) called for a 30 percent increase in U.S. medical school enrollment. Several years of flat enrollment has raised concern that our nation will soon experience a dearth of physicians.

The AAMC’s recommendation was met with objections. Writing in The New York Times, David C. Goodman, professor of pediatrics at Dartmouth Medical School, suggested that we in fact have too many doctors. Healthcare quality “does not rise along with the number of doctors,” he argued, citing several studies. Goodman makes some valid points. Simply training more physicians will not necessarily result in better outcomes. But like the scientist, Goodman is missing the point. His well-reasoned piece implicitly blames physicians for “accelerating costs, poor quality of care, and the rising ranks of the uninsured.” It’s wrong for anyone to draw that conclusion. Physicians are not to blame for our healthcare system’s shortcomings.

One shortcoming is the rising ranks of uninsured. It’s good to see that more than a dozen states are experimenting with ways to reduce this number.

“To me, healthcare is a fundamental right,” says Illinois Governor Rod R. Blagojevich. Last winter, he pushed his legislature to enact a program that will guarantee access to health insurance to all Illinois children. Federal programs now cover all but 250,000 Illinois children. With Blagojevich’s prodding, most of those should be covered, paid for by fees from families, federal dollars, and reductions in other state programs. Such efforts are playing out elsewhere as state lawmakers across the country face tightening budgets caused by rising healthcare costs and and a political environment that is making inaction less desirable.

In Massachusetts, Gov. Mitt Romney - a likely candidate for the 2008 Republican presidential nomination - pushed a measure that provides for near-universal coverage in his state. It requires everyone to purchase insurance, and it provides a market for the poor.

Romney insists the new law will reduce costs without necessitating new taxes or onerous government oversight.

Similar efforts are underway in several other states. For years, consumers, voters, and state officials expected that any movement toward universal coverage would come through federal action. But with conservatives running the White House and Congress, pressure is building for the states to act.

Clever politicians like Romney, Blagovevich, and others see federal inaction as an opportunity for them.

So long as policies are clear, and funding is secure, these state programs are a step in the right direction for both consumers and physicians. As more Americans find themselves without healthcare coverage, the likelihood grows that federal policymakers will accede to physicians’ requests on a variety of topics, such as reimbursement and insurance malpractice caps. Easing the number of Americans without healthcare coverage will help millions of Americans live better lives - no matter how many doctors we have.

What do you think? Write to me at kkarpay@physicianspractice.com. The views expressed here are my own and do not necessarily reflect those of Physicians Practice.

This article originally appeared in the September 2006 issue of Physicians Practice.