- The Washington Times - Wednesday, January 2, 2008

Training more doctors to serve an aging population could drive up already crippling health care costs, medical officials say.

An influx of doctors will increase costs on an already financially troubled Medicare system, researchers at Dartmouth Medical School contend.

“Calling for more doctors, like prescribing more drugs, for an already overmedicated patient, may only makes things worse,” said Dr. David Goodman, a professor of pediatrics and family medicine at Dartmouth Medical School, which researches heath care quality and costs.

The recent push for more doctors is a result of a policy reversal by two groups, which until 2006 projected a physician surplus. Now, the Association of American Medical Colleges says medical schools should increase enrollment 30 percent by 2015. The increase would result in an additional 5,000 new medical students each year.

The number of doctors being trained now may not be sufficient to take care of baby boomers when they reach their 80s and 90s, according to the AAMC and the Council on Graduate Medical Education, which advise the federal government on how many residency positions to fund.

The 2007 entering class to medical schools is the largest in the nation’s history, according to the AAMC. The number of first-year enrollees totals almost 17,800, a 2.3 percent increase over 2006.

A number of factors went into the groups’ decision to push for more doctors, including a doubling in the number of people over age 65 between 2000 and 2030, and an aging physician work force — one out of every three doctors is over age 55 and likely to retire by 2020, according to the AAMC.

“Given the extensive time it takes to educate and train tomorrow’s doctors, efforts to increase enrollment must get under way as soon as possible to ensure that the health care needs of the nation in 2015 and beyond are met,” said Dr. Jordan Cohen, president of the AAMC.

Dr. Goodman points out that graduate school medical education programs are funded by state governments and residencies are largely funded through Medicare. The portion of Medicare that pays for hospital stays in scheduled to run out of money by 2016.

“We already have a crisis in Medicare, we know that. We don’t know how to pay for future Medicare expense at present, and no one has considered the implication of adding a large number of physicians,” he said.

Dr. Goodman said the costs that doctors put into the health care system through the services they provide and the drugs they prescribe will add unnecessary expenses.

“The physicians’ fees are expensive, but once they enter the medical marketplace, no one has estimated the cost of the decisions they make. They order tests, prescribe medications, they really control health care cost in the U.S.,” he said.

The expected oversupply extends back a decade. By 1997, Congress capped the number of residency slots to train medical school graduates in the U.S. The cap was designed to save money and rein in the number of doctors who analysts said would flood the labor market.

A 1994 study by the Journal of the American Medical Association predicted a surplus of 165,000 doctors by 2000. The supply of specialty doctors, such as neurologists and gastroenterologists, was expected to exceed demand by 60 percent, according to the journal.

Dr. Goodman and his colleagues say studies have shown that the quality of care does not rise along with the number of doctors.

“There are not enough incentives in the market for doctors to go where they are needed most,” he said. “More doctors does not mean the aging population will get the care it needs.”

Instead, he said, it is likely new physicians will practice in affluent areas where there is already a high quality of life, such as New York and Miami.



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