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Book Review   |    
Sidney Weissman
Psychiatric Services 2009; doi:
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by Richard M. Scheffler; Stanford, California, Stanford University Press, 2008, 256 pages, $27.95

Dr. Weissman is professor of clinical psychiatry, Feinberg School of Medicine, Northwestern University, Chicago.

Consideration of the number of doctors our country needs is usually left to academic physicians and health care economists. This year, as the country is engaged in a major debate on health care reform, the issue is front and center. Physicians, by their decisions, have a great impact on the cost of society's health care expenditures. It is argued by some that if the country has an excess of physicians, the excess will add to the nation's health care costs. At this point in the health care reform debate, Richard Scheffler's Is There a Doctor in the House? is a welcome resource as we address the question of how many doctors the United States needs to facilitate health care reform.

Scheffler has the ability to present economic theory and data in an entertaining fashion that both informs and compels us to examine our prior beliefs about the complex question of whether the United States has a shortage or surplus of doctors. He reviews the varied theories that are used to argue for each position. He clearly presents his position, and yet he does so as a teacher leaving the student ample opportunity to disagree. He presents data that would argue that the current supply of physicians in the United States is adequate, although there are distribution issues. Nonetheless he acknowledges the difficulty in predicting how many physicians the nation needs. Therefore, because a shortage would create potential hardships, he urges that we increase the number of U.S. medical school graduates by 10% to 20%. He observes that today nearly a quarter of new U.S. physicians are international medical graduates. If we indeed created a major surplus we could reduce the surplus by reducing the nation's reliance on international medical graduates.

Scheffler also proposes that we can reduce the nation's need for more physicians and by so doing reduce health care expense. He argues that in a number of areas nurse practitioners and physician assistants can perform 70% of the work of physicians at 30% of a physician's salary. These providers could be expanded to both reduce health care expenditures and reduce the need for more doctors. The reduced need, he argues, is important in that it costs $1 million to produce a practicing doctor.

This easy-to-read, important volume is essential reading for everyone interested in our nation's need to effectively reform health care.

The reviewer reports no competing interests.

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