Is There a Doctor in the House?

"Will there be a doctor--a good doctor--when I need one?" This is the bedrock health care concern for Americans, encompassing as it does additional concerns about affordability, accessibility, efficiency, and specialty expertise. Richard M. Scheffler brings an economist's insight to the question, showing how shifts in market power underlie the changes we have seen in the health workforce and how they will affect the future availability of doctors. Predicting the "right" ratio of doctors to population in the future is only a small piece of the puzzle, and one that has been the subject of much forecasting, and little agreement, over the past several decades. In this concise and readable analysis, Scheffler goes beyond the guessing game to demonstrate that today's health care system is the product of financial influences in both the policy realm and on the ground in the offices of medical centers, HMOs, insurers, and physicians throughout America. He shows how factors such as physician income, medical training costs, and new technologies affect the specialties and geographic distribution of doctors. Scheffler then brings these findings to bear on a set of predictions for the U.S. and international physician workforce that extend five and ten years into the future. As part of his vision of tomorrow's ideal workforce, he offers a template for enhancing the efficiency and cost-effectiveness of the health care system overall. In the groundbreaking second half of the book, the author, a health policy expert himself, tests his ideas in conversations with leading figures in health policy, medical education, health economics, and physician practice. Their unguarded give-and-take offers a window on the best thinking currently available anywhere. Finally, Scheffler combines their insights with his own to offer observations that will change the way health care's stakeholders should think about the future.

Richard M. Scheffler is Distinguished Professor of Health Economics and Public Policy at the University of California, Berkeley and holds the Chair in Healthcare Markets & Consumer Welfare endowed by the Office of the Attorney General for the State of California.