Dr. Fye and his colleagues at the ACC are to be congratulated for calling attention to the plight of cardiology or, more correctly, the plight of patients who will need cardiologists but who, because of shortages, will lack the opportunity to see them. It's a sad day when Americans cannot access the advanced cardiac care that our nation has invested so heavily in creating while billions are squandered on regulation, litigation, and other administrative intrusions. These not only add cost but, as Dr. Pedre notes, also create bureaucratic burdens that force physicians to leave practice altogether. It is also sad that, while physician shortages were evolving, the Council on Graduate Medical Education was steadfast in forecasting impending physician surpluses, not because, as Drs. Curry and Barganier suggest, the AMA Masterfile is wrong (although it is far from perfect), but rather because the Council's methodology was wrong. Indeed, the Council used the same AMA data in its more recent model, fashioned after our own, which caused it to reverse course and acknowledge that the problem was one of shortages rather than surpluses (1).

In their accompanying editorial, Drs. Garber and Sox (2) sought comfort in the notion that the United States may not need more physicians because older folks are healthier these days and don't require as much care. Of course, they're healthier because of their stents, artificial hips, and cataract operations, and despite these aids, they're certain to encounter disease and its costly therapy still later in life. But most of this care isn't even necessary, at least if one accepts the "supplier-induced demand" argument, as Drs. Garber and Sox have done. This notion springs from an observed correlation between the number of surgeons and the amount of surgery, but a similar correlation exists between obstetricians and babies (3), so where does the demand originate? And lest anyone think that the advances of the past 3 decades have added value, the editorialists dutifully recite the "more is worse" catechism (4), a statistical artifact of population clustering. Most terrifying is their notion that price will control demand, a disastrous scenario in which shortages of physicians will lead to such steep increases in cost that use will fall because most people won't be able to afford care, so why produce more physicians anyway? One can only hope that reason will prevail.