Main description:

"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.

Contents:

@fmct:Contents @toc4:Acknowledgments xxx @toc1:Part 1 Market Power and the Doctor Supply @toc2:Chapter 1 The Supply Cycle of Doctors 000 Chapter 2 Managed Care Redistributes Market Power 000 Chapter 3 Physician Incomes: Following the Money 000 Chapter 4 Who Are the Doctors, and Where Are They? 000 Chapter 5 Reshaping the Workforce: Nurse Practitioners and Physician Assistants 000 Chapter 6 Doctor Supply Forecasts: More or Less 000 Chapter 7 The "Right" Number of Doctors in a Better Health Care System 000 @toc1:Part 2 Conversations with the Experts @toc2:Toward Tiered High-Performance Networks @tocca:Alain C. Enthoven, Stanford University 000 @toc2:Primary Care and the Medical Home @tocca:Karen Davis, The Commonwealth Fund 000 @toc2:Rethinking the Financing of GME @tocca:Gail Wilensky, Project HOPE 000 @toc2:What the Market Signals Are Saying @tocca:Mark V. Pauly, University of Pennsylvania 000 @toc2:Residents, Payment, and the Global Market @tocca:Joseph P. Newhouse, Harvard University 000 @toc2:Physician Income and the Potential of P4P @tocca:Uwe E. Reinhardt, Princeton University 000 @toc2:Measuring Performance: How and Why @tocca:Peter R. Carroll, University of California, San Francisco 000 @toc2:Paying for Primary Care in an Outmoded System @tocca:Jordan J. Cohen, Arnold P. Gold Foundation 000 @toc2:Advanced-Practice Clinicians Challenge Traditional Model @tocca:Tracey O. Fremd, California Association for Nurse Practitioners 000 @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 Improvement 000 @toc2:Understanding the Real Cost of Medical Education @tocca:Atul Grover, Association of American Medical Colleges 000 @toc2:Primary Care: How Much Does Money Matter? @tocca:Kevin Grumbach, University of California, San Francisco 00 @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 University 000 @toc2:Too Many Doctors, Too Little Efficiency @tocca:Arnold Milstein, William M. Mercer 000 @toc2:Taking Responsibility for Generating America's Doctors @tocca:Fitzhugh Mullan, George Washington University 000 @toc2:We Expect Too Much from Physicians @tocca:Edward O'Neil, University of California, San Francisco 000 @toc2:The Integrated System: Paying for Primary Care @tocca:Robert Pearl, Kaiser Permanente 000 @toc2:The Declining Role of Government: It's Time to Prepare @tocca:Philip A. Pizzo, Stanford University 000 @toc2:Tomorrow's Doctors Want Something Different @tocca:Edward S. Salsberg, Association of American Medical Colleges 000 @toc2:The Medical Home and Other Ways to Save Primary Care @tocca:Steven Schroeder, University of California, San Francisco 000 @toc2:External Reporting and Other Keys to P4P @tocca:Stephen M. Shortell, University of California, Berkeley 000 @toc2:What the Business Model and the Military Model Know @tocca:Mark D. Smith, California HealthCare Foundation 000 @toc2:More Doctors Does not Equal Better Outcomes @tocca:John E. Wennberg, Dartmouth Institute for Health Policy and Clinical Practice 000 @toc2:Doctors as Team Players @tocca:William J. Barcellona, California Association of Physician Groups 000 @toc2:Doctors: Stop Being Depressed and Redesign the System @tocca:Ian Morrison, Institute for the Future 000 @toc2:A Final Word 000 @toc4:Appendix A: The Cost of Training a Doctor and the Return on Investment 000 Appendix B: Methodology for Forecasting Doctor Shortages 000 Notes 000 Index 000