Yet despite such attitudes, or perhaps because of them, Gudakunst and other young physicians are a prized commodity. With a recent survey by the American Hospital Association finding significant workforce shortages at nine of 10 hospitals, most hospitals and medical practices across the country are actively recruiting physicians, and often it’s an uphill battle. Not long ago, according to the MGH’s Nicholson, the hospital had 10 qualified applicants for every open primary care position. During the past two years, however, there were only 30 qualified applicants to fill 20 slots. For the first time the hospital has hired a physician recruiter, and it is considering sweetening incentive packages, Nicholson says.

Most estimates of future medical personnel needs assume that spending on health care will continue to grow much faster than the overall economy. But Dartmouth’s Goodman, among many others, doesn’t think the country can afford an endless expansion of health care spending. Rather than race to produce additional doctors who will order still more services for their patients, he wants to reform what he believes is a dysfunctional system. “Almost everyone working on the problems of health care considers the system unsustainable in terms of quality and costs,” Goodman says. “Rather than spend resources on training more physicians, we should focus on building more efficient delivery systems.”

Instead, medicine could move toward using caregivers who aren’t physicians, particularly in primary care. The MGH’s John D. Stoeckle Center for Primary Care Innovation, for example, is exploring the concept of team medicine, in which each patient will have a designated corps of nurse practitioners and doctors, allowing doctors to spend more time with patients who need extensive or specialized attention. The increased use of electronic health records could also help ease the doctor crunch, says Stoeckle Center executive director Susan Edgman-Levitan, by reducing the time team members spend tracking down files and scribbling in notes. “There has been a lot of discussion about the need to pay primary care physicians more and change the reimbursement model, but a lot less has been said about how to redesign the actual delivery of care in a way that remains safe but is also more efficient,” she says.

Yet even with changes in how care is provided, solving the physician supply issue is likely to remain an elusive goal. Determining how many doctors are actually needed, and where, is an inexact science at best, and medical advances, if their effect is to keep people alive even longer, could mean demand for medical services will increase at an even faster rate in coming decades. But federal policymakers, who control the purse strings, seem disinclined or unable to fund a perpetual expansion of the system. Still, to sit tight and let medical economics take its course risks putting more pressure on an already overtaxed health care system.

Dossier

1. “New Steam From an Old Cauldron—The Physician-Supply Debate,” by David Blumenthal, The New England Journal of Medicine, April 22, 2004. A comprehensive analysis of the revived debate about the physician workforce, analyzing methodology, ideological and social underpinnings and how policymakers may approach solutions.

2. “End-of-Life Care at Academic Medical Centers: Implications for Future Workforce Requirements,” by David Goodman et al., Health Affairs, March/April 2006. Groundbreaking study that challenges those who argue the physician workforce needs expanding and that contends states with the most medical specialists and general internists have lower quality of care than those with fewer.

3. Will the Last Physician in America Please Turn Off the Lights?: A Look at America’s Looming Doctor Shortage, by James Merritt et al. (MHA Group, 2004). Data, surveys and analysis provided by a leading physician-recruiting firm that support the growing doctor shortage based on such workforce measures as appointment waiting times, practice profiles and recruiting-package incentives.

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