
Is There a Doctor in the House?
Market Signals and Tomorrow's Supply of Doctors
Richard M. Scheffler(Author)
Stanford University Press
Published on 23. September 2008
Book
Hardback
256 pages
978-0-8047-0032-0 (ISBN)
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.
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.
Reviews / Votes
"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)More details
Edition
New edition
Language
English
Place of publication
Palo Alto
United States
Target group
College/higher education
Professional and scholarly
Edition type
New edition
Product notice
Cloth
Illustrations
15 tables, 17 figures
Dimensions
Height: 233 mm
Width: 160 mm
Thickness: 21 mm
Weight
476 gr
ISBN-13
978-0-8047-0032-0 (9780804700320)
Copyright in bibliographic data and cover images is held by Nielsen Book Services Limited or by the publishers or by their respective licensors: all rights reserved.
Schweitzer Classification
Person
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.
Content
@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