Is There a Doctor in the House?

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.

"Today's medical students will help mold the health care delivery system of and in the future. It follows that they should read this exceedingly readable volume and consider its implications for they must understand the issues in order to participate effectively in the design of the system in which they will work to advance their patients' and the nation's health." - Rashi Fein, Professor of Medical Economics, Emeritus (Harvard Medical School) "This book is a pleasure to read, very engaging, and (most importantly) very accessible to non-economists who will end up learning a lot of health market economics painlessly.—Mark Pauly, Department of Health Care Management, Wharton School, University of Pennsylvania "Questions about how many and what kinds of doctors the country needs are front and center in the current debate about health care reform. Everyone interested in the future of our healthcare system, especially students planning careers in the health professions, would benefit from engaging this very readable book." - Jordan J. Cohen, MD, Professor of Medicine and Pubic Health, George Washington University, and President Emeritus (Association of American Medical Colleges) "I salute Richard Scheffler for getting his arms around such a huge topic. The twenty-six interviews in the back of the book are alone worth the price of admission. Scheffler asks great questions and, more often than not, gets great answers. It's like sitting down to a dinner party with many of the most important policy thinkers in health today—a great read." - Fitzhugh Mullan, M.D., Murdock Head Professor of Medicine and Health Policy (The George Washington University) "Professor Richard Scheffler provides a refreshing new perspective on the origins and possible solutions to the U.S. and global health workforce crisis. His book is a must-read for both U.S. policy-makers and the international development community." - Alexander S. Preker, Lead Economist (World Bank) "Scheffler concludes that a modest increase in physician supply (10-20 percent) is justified, but that the organization of practice and the orientation of incentives are more important in the long run. What is truly unusual and useful about the book are the 27 commentaries, a refreshingly informal set of conversations with more than a score of knowledgeable physicians and academic experts in the field." - CHOICE "Is There a Doctor in the House? is one of the very few books on workforce issues to appear in the past decade, and Richard Scheffler makes a notable contribution to the debate. He avoids the temptation of a simple thumbs-up or thumbs-down on whether to increase graduate medical education training, and instead provides an intriguing analysis of the economics of the physician labor market, through its periods of perceived scarcity and surplus up to the current era of uncertainty." - New England Journal of Medicine "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.... This easy-to-read, important volume is essential reading for everyone interested in our nation's need to effectively reform health care." - Psychiatric Services "Physicians have been and continue to be central to the delivery of medical services. Physician supply affects access to care and also physicians' willingness to participate in managed care plans and new delivery systems. Is There a Doctor in the House? is a thoughtful and timely discussion of the adequacy of the supply of physicians in coming years, and it should be of value to those with a special interest in health care workforce policy." - Paul Feldstein, Paul Merage School of Business (University of California at Irvine) "The dramatic global health work force crisis is accompanied by a lack of knowledge about its labor market mechanisms. With this book, Richard Scheffler brings us a very important analytical work, looking at how the US is linked globally, and contributing to a better understanding of the crisis and possible options for tackling it." - Mario R. Dal Poz (World Health Organization)

• @fmct:Contents @toc4:Acknowledgmentsxxx @toc1:Part 1Market Power and the Doctor Supply @toc2:Chapter 1The Supply Cycle of Doctors000 Chapter 2Managed Care Redistributes Market Power000 Chapter 3Physician Incomes: Following the Money000 Chapter 4Who Are the Doctors, and Where Are They?000 Chapter 5Reshaping the Workforce: Nurse Practitioners and Physician Assistants000 Chapter 6Doctor Supply Forecasts: More or Less000 Chapter 7The "Right" Number of Doctors in a Better Health Care System000 @toc1:Part 2Conversations with the Experts @toc2:Toward Tiered High-Performance Networks @tocca:Alain C. Enthoven, Stanford University000 @toc2:Primary Care and the Medical Home @tocca:Karen Davis, The Commonwealth Fund000 @toc2:Rethinking the Financing of GME @tocca:Gail Wilensky, Project HOPE000 @toc2:What the Market Signals Are Saying @tocca:Mark V. Pauly, University of Pennsylvania000 @toc2:Residents, Payment, and the Global Market @tocca:Joseph P. Newhouse, Harvard University000 @toc2:Physician Income and the Potential of P4P @tocca:Uwe E. Reinhardt, Princeton University000 @toc2:Measuring Performance: How and Why @tocca:Peter R. Carroll, University of California, San Francisco000 @toc2:Paying for Primary Care in an Outmoded System @tocca:Jordan J. Cohen, Arnold P. Gold Foundation000 @toc2:Advanced-Practice Clinicians Challenge Traditional Model @tocca:Tracey O. Fremd, California Association for Nurse Practitioners000 @toc2:Chronic Care Models and Turf Battles @tocca:Gary Gitnick, University of California, Los Angeles 000 @toc2:Free Medical Education--with Strings @tocca:Donald Goldmann, Institute for Healthcare Improvement000 @toc2:Understanding the Real Cost of Medical Education @tocca:Atul Grover, Association of American Medical Colleges000 @toc2:Primary Care: How Much Does Money Matter? @tocca:Kevin Grumbach, University of California, San Francisco00 @toc2:A Regional Approach to Health Disparities @tocca:Risa Lavizzo-Mourey, Robert Wood Johnson Foundation 000 @toc2:A Short History of Medical Education and Diversity @tocca:Philip R. Lee, Stanford University000 @toc2:Too Many Doctors, Too Little Efficiency @tocca:Arnold Milstein, William M. Mercer000 @toc2:Taking Responsibility for Generating America's Doctors @tocca:Fitzhugh Mullan, George Washington University000 @toc2:We Expect Too Much from Physicians @tocca:Edward O'Neil, University of California, San Francisco000 @toc2:The Integrated System: Paying for Primary Care @tocca:Robert Pearl, Kaiser Permanente000 @toc2:The Declining Role of Government: It's Time to Prepare @tocca:Philip A. Pizzo, Stanford University000 @toc2:Tomorrow's Doctors Want Something Different @tocca:Edward S. Salsberg, Association of American Medical Colleges000 @toc2:The Medical Home and Other Ways to Save Primary Care @tocca:Steven Schroeder, University of California, San Francisco000 @toc2:External Reporting and Other Keys to P4P @tocca:Stephen M. Shortell, University of California, Berkeley000 @toc2:What the Business Model and the Military Model Know @tocca:Mark D. Smith, California HealthCare Foundation000 @toc2:More Doctors Does not Equal Better Outcomes @tocca:John E. Wennberg, Dartmouth Institute for Health Policy and Clinical Practice000 @toc2:Doctors as Team Players @tocca:William J. Barcellona, California Association of Physician Groups000 @toc2:Doctors: Stop Being Depressed and Redesign the System @tocca:Ian Morrison, Institute for the Future000 @toc2:A Final Word000 @toc4:Appendix A: The Cost of Training a Doctor and the Return on Investment000 Appendix B: Methodology for Forecasting Doctor Shortages 000 Notes000 Index000