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The New England Journal of Medicine Review [PDF]

"Will there be a doctor — a good doctor — when I need one?" This is the bedrock health care question for all Americans, one that encompasses critical concerns about affordability, accessibility, efficiency and specialty expertise. In "Is There A Doctor In The House? Market Signals and Tomorrow's Supply of Doctors," (Stanford University Press, September 2008), Petris Center Director Richard M. Scheffler upends conventional thinking, as he shows how the United States is not suffering from a shortage of doctors — it is seeing the results of decades of misguided public policies. These policies have created a health care marketplace that often fails to deliver the right number of doctors, of the right specialty, in the right locations.

Scheffler explains how today's health care system is the product of economic and financial influences in both the policy realm and on the ground, in the offices of hospitals, insurers, and physicians throughout America.

Health care reform, Scheffler argues, is not just a matter of training more doctors. What this country needs is a reform of health care policy, which will spur the development of an efficient, cost-effective, and high-quality health care system. Scheffler delivers a series of important recommendations for repairing the system:

• Increased use of team-based medicine, with physician assistants and nurse practitioners playing larger roles in patient care;
• IT implementation;
• Improvements in patient safety;
• Pay-for-performance programs;
• Modest increases in the number of physician trainees;
• Most importantly, physician payment systems that attract doctors to the venues where they are needed most.

In the groundbreaking second half of the book, Scheffler tests his ideas in conversations with 27 leading figures in health policy, medical education, health economics and physician practice. Their unguarded give-and-take offers a window on the best thinking currently available anywhere.

Scheffler also brings his findings to bear on a set of predictions for the U.S. and international physician workforce, which could aid efforts to avoid projected global disparities in access to doctors.

Praise for Is There A Doctor In The House?

Scheffler's book resembles 'Freakonomics' in its intriguing dissection of the incongruity between perceptions of physician shortages and the facts on the ground. Scheffler offers an excellent antidote to much of the atheoretical literature that dominates this field, which so often results in an erroneous understanding of the underlying dynamics. — David Mechanic, Rutgers University

Physicians are central to the delivery of medical services. Physician supply affects not only access to care, but also physicians' willingness to participate in new delivery systems, such as managed care plans. This thoughtful and timely discussion will be of particular value to those concerned with health care workforce policy. — Paul Feldstein, Paul Merage School of Business, University of California, Irvine

The billions of dollars spent each year on health care in low-income countries are at risk of being wasted, because of a critical shortage of appropriately trained health workers. Scheffler provides a refreshing new perspective on the origins and possible solutions to this global human resources crisis. It is a must read for both U.S. policy makers and the international development community. — Alexander S. Preker, Lead Economist, World Bank

The dramatic global health work force crisis is accompanied by a lack of knowledge about its labor market mechanisms. With this important analytical work, Scheffler contributes to a better understanding of the crisis, explaining how U.S. and global issues are linked and offering possible options for tackling it. — Mario R. Dal Poz, World Health Organization

This book shows that there is no easy answer to the question that the title poses. The author pleads for a change in the way we pose questions that are at the heart of the role played by the medical profession in a market-oriented economy. — Barbara Starfield, Johns Hopkins School of Public Health