Your Sept. 6 editorial on supply, demand and doctors was right on the money in pointing out that the immutable laws of economics are not so immutable when applied to health care, where increased supply can create more demand and higher prices. But your conclusion ignores the role economics plays in the career choices individual physicians make.
The editorial calls for an education system that produces doctors trained and motivated to go where they’re needed most. Northwestern University Medical School has as its explicit goal educating students as undifferentiated generalists, capable of pursuing any career in medicine. But motivation is more complex. There are pressures and influences outside the school’s influence that play a major role in graduates’ choice of specialty:
– Economic inducements. Specialists continue to earn more than generalists, and this fact is not lost on students who have invested heavily in becoming physicians. Borrowing $100,000 to finance a medical education is no longer uncommon.
– Intellectual issues. Mastering the art and science of medicine is a prodigious feat. For some, specializing in a particular part of the discipline–neurology, cardiovascular surgery, ophthalmology, etc.–provides an opportunity to master a portion of the knowledge of medicine at a level that a generalist cannot match.
Other issues also come into play. Some specialties have more regular hours than others. Someone with poor patient communication skills but excellent technical medical skills may do better in a specialty where their clients are generalist physicians rather than patients.
Medical schools and the environment they create bear part of the blame for the overspecialization of American medicine.
But medical schools alone will not change the ratio of specialists to generalists. The only sustainable way to achieve that goal is to improve the terms and conditions of employment–most notably compensation–for generalists relative to specialists. Providing financial incentives, such as loan forgiveness, for students electing to pursue generalist careers could accelerate the process.
