The current medical education system and reimbursement policies in the United States have contributed to a maldistribution of physicians by specialty and geography. The causes of this maldistribution include financial barriers that prevent the individuals who would be the most likely to serve in primary care and underserved areas from entering the profession, large taxpayer subsidies to teaching hospitals that provide incentives to act in ways that are not in the best interest of society, and reimbursement policies that discourage physicians from providing primary care. The authors propose that the maldistribution of physicians can be addressed successfully by reducing the financial barriers to becoming a primary care physician, aligning subsidies with societal interests, and providing financial incentives that target primary care. They suggest that the Patient Protection and Affordable Care Act of 2010 takes steps in the right direction but that more financially prudent measures should be taken as politicians revisit health care reform with heightened financial scrutiny.
Dr. Dorsey is associate professor of neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Dr. Nicholson is associate professor, Department of Policy Analysis and Management, Cornell University, Ithaca, New York.
Dr. Frist is former majority leader, U.S. Senate, and, at the time of writing, was University Distinguished Professor (2009–2010), Vanderbilt University, Nashville, Tennessee.
Editor's Note: This is a commentary on Petterson S, Burke M, Phillips R, Teevan B. Accounting for graduate medical education production of primary care physicians and general surgeons: Timing of measurement matters. Acad Med. 2011;86:605–608.
Correspondence should be addressed to Dr. Dorsey, 600 N. Wolfe St., Meyer 6-181D, Baltimore, MD 21287; telephone: (410) 614-5991; fax: (410) 502-6737; e-mail: email@example.com.