South Florida Hospital News
Monday October 26, 2020
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August 2008 - Volume 5 - Issue 2
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Medical Manpower and the Imperative to Heal

Back in the Neolithic age when, I was applying to medical school, there was a national consensus that the United States was threatened with a shortage of physicians. Federal support for medical school education increased (transiently), classes were expanded (which is a difficult thing to accomplish in this highly resource-dense field), and new medical schools were opened. Federal dollars were devoted toward paying for medical school in return for years of national service in underserved areas. Now, over thirty years later, we appear to be facing a similar situation. Much of the current physician work force is in the senior portion of their careers, especially in the surgical fields. Issues of dropping compensation, increasing business and government involvement in healthcare, and medical liability have all impacted interest in the profession. However, despite these concerns, interest in medicine as a career remains robust applications to medical schools exceed available spaces by nearly three-to-one yet there still seems to be a shortage of American graduates available to fill all of the available residency training programs. The solution would seem simple once again open the doors to new medical schools and increase the pool of American-educated physicians. The exorbitant price of medical school today (well over $25,000 per year) would certainly provide many opportunities to fulfill national mandates in areas of physician shortage.

Unfortunately, as with all issues in the American healthcare system, the issue is much more complex. Historically we have an important question that begs response: when we increased physician supply in the 1970s, did we improve health care? Even if that question is too difficult to answer, we might ask a more basic question: what is the evidence that increasing physician supply results in improved health care? The logic would seem obvious: doctors deliver heath care; therefore, the more doctors, the better healthcare. Unfortunately, the reality is more troublesome. There is evidence from the Dartmouth Health Atlas that would seem to suggest just the opposite in a given setting, an increase in physician supply may have no measurable benefit in health care, or may even be detrimental. The potential explanations are beyond the scope of this article. Suffice it to say that it is not adequate merely to look at the "work units" produced by the physicians, but rather to examine the health outcomes of the population that they are treating. Such an approach would require a level of coordination in the delivery of services that may not be readily available in the multi-faceted healthcare environment we currently support. Access to care requires more than numbers, it requires distribution of physicians within an effective framework of delivery. Delivery requires patient/physician interactions within a context of ongoing care that will foster effective health management. Funding may not be greater or may in fact be much less than what is currently spent, but must address the considerable economic impact of the healthcare system, which is currently one of the leading segments of our economy. In other words, how many jobs or profits would be lost if a more efficient system were devised from the standpoint of health outcome?

These are obviously more complex issues than would immediately seem apparent. And the answers await carefully conceived strategies rather than knee-jerk reactions. However, whether we are addressing the issue of health manpower, or the role of genetics and stem cells in current therapy, the Florida Heart Research Institute, due to our unique independent status, is able to approach complex problems without institutional bias, and to focus primarily on the health and well-being of our fellow citizens.

Dr. Paul Kurlansky, board certified cardiothoracic surgeon, Director of Research at the Florida Heart Research Institute, can be reached at (305) 674-3154 or pak@floridaheart.org.
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