U.S. Needs More Physicians Soon, but How Many More Is Debatable

When Richard A. Cooper, MD, first starting investigating the question of how many physicians the United States needed in its work force, the common wisdom of the early 1990s held that the country was facing a major physician surplus. The surplus would push down physician salaries and leave some searching for employment. But as Cooper spent more time studying the numbers of graduates from U.S. medical schools and residents in training, he determined a completely different future: The United States instead faced a looming shortage that threatened to overtax and weaken the health care system by the early 21st century. Cooper first published his findings in a medical journal in 1994, and the controversy that he fueled continues to this day (1).

The health care work force has expanded rapidly in recent years, with nonphysician providers, graduates of international medical schools (IMGs), and osteopaths augmenting a stable supply of about 16 000 graduates per year from U.S. medical schools. Would the American public be better off if the country produced more MDs? Some experts in work force issues, including Cooper, believe that the answer is yes, considering the growing U.S. economy, the growing population (particularly the growing number of elderly people), and the possibility of enhancing the position of allopathic medicine in American health care. “If we value allopathic medicine, and I don't think anybody would argue that allopathic medicine catapulted the United States to become the world leader in medicine, then we have to do something about the fact that this profession is allowing itself to be nibbled away by failing to recognize and respond to patient need for more health care,” said Cooper, a past dean of the medical school at the University of Wisconsin and, more recently, a professor of medicine at the Leonard Davis Institute at …