ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Wednesday, February 21, 1996 TAG: 9602210017
SECTION: EDITORIAL PAGE: A-7 EDITION: METRO
SOURCE: NEAL A. VANSELOW AND DON E. DETMER
THE U.S. health-care system, already under stress, is about to receive another blow. The United States is training many more physicians than it will need in the years ahead.
Having more than enough physicians is better than having too few. But the looming glut of doctors could drive health-care costs even higher and scare many of America's most talented young people away from a distinguished profession.
Wouldn't an oversupply of physicians reduce costs and increase access to care? No. In fact, the evidence suggests just the opposite. Under the fee-for-services arrangement still common in American medicine, more doctors generally mean more medical procedures and higher costs. A doubling of the physician work force over the past 25 years has not reduced costs or guaranteed care for every American. Statistics show that access to care has worsened.
Producing far more physicians than the nation requires also wastes federal funds. The Medicare program alone spends more than $6 billion annually on the training of physicians after they graduate from medical school and enter their residencies.
This subsidy helps guarantee the quality and diversity of the physician work force. But if far too many physicians are trained, these expenditures eventually will create more problems than they solve.
Finally, there are the human costs. Many bright young Americans want to become doctors. The number of applicants to U.S. medical schools is at an all-time high. If there prove to be too many doctors and too few jobs in the future, the time and money that many students have spent on their education and training will turn out to be very poor investments. Our most talented youth may turn to other careers, and the nation's health care will suffer.
Much of the recent pressure on the physician work force can be traced to a specific source. About a quarter of the residents in America's teaching hospitals are graduates of foreign medical schools, and the majority of them stay in this country to practice once their training is completed. These international medical graduates - most of whom were not born in this country - already represent as many students as would graduate from 50 foreign medical schools. And their numbers have been rising steadily in recent years, while the number of residents from American medical schools has held level.
Graduates of foreign medical schools have enriched the nation for many years. But the sons and daughters of American taxpayers should have the opportunity to practice medicine here if they are qualified and committed. Supporting the residency training of large numbers of international medical graduates also deprives other nations of their most able young people.
The federal government should reduce the number of residency positions it subsidizes, and the graduates of American medical schools should have priority for these positions. Hospitals still could accept the graduates of foreign medical schools, but federal funds should not pay for their training. No new medical schools should be opened, and existing schools should not increase in size.
Some groups have recommended closing American medical schools or decreasing class size. But we should not make it harder for young Americans to go to medical school, especially while leaving open opportunities for doctors from abroad. Also, medical schools still are working to increase the number of minorities in medicine, and downsizing medical schools would make it harder to achieve this important goal.
A relatively small number of hospitals, especially those in inner cities, use international medical graduates supported with federal funds to deliver significant amounts of health care to the poor. These hospitals will have trouble meeting local needs if the number of residencies is severely reduced. The federal and state governments must replace the funding previously provided through residency training, and this funding should continue until a way is found to provide universal access to basic health-care services.
The health-care system in this country is undergoing radical, rapid and unpredictable changes. Even the practical steps we have suggested may have unforeseen consequences; continued debate and evaluation are essential. But we need to take action - and soon - or the problems that are emerging today will become far greater in the future.
Neal A. Vanselow is professor of medicine at Tulane University School of Medicine in New Orleans. Don E. Detmer is senior vice president of the University of Virginia in Charlottesville. They recently co-chaired the Institute of Medicine's Committee on the U.S. Physician Supply.
LENGTH: Medium: 84 lines ILLUSTRATION: GRAPHIC: Nancy Ohanian/Los Angeles Timesby CNB