UNC News Service

CHAPEL HILL -- "How many doctors do we have and how many do we need?"

These questions are critical in the debate over health care reform now before Congress, says UNC Gillings School of Global Public Health professor Thomas Ricketts in an editorial in the Oct. 21 issue of the Journal of the American Medical Association (JAMA).

Ricketts' editorial accompanies an analysis of estimates of physicians practicing in the United States. Understanding how many physicians are needed, and how many physicians are available, is a critical part of making health care reform work, he explains. The accuracy of estimates of the current and future supply of physicians is very important to understanding what we will spend on health care and how we should invest in training doctors. However, he questions the accuracy of the current methods of counting those physicians.

Ricketts, a UNC professor of health policy and management, suggests that the method of collecting such data could and should be more reliable, and should take into account not only the number of licensed, practicing physicians, but also the number of hours they work and the number of patients they see.

"The importance of the study (of practicing physicians) is not about the method but whether the actual number is too many or too few," Ricketts writes. "The central policy question is how much public resources should be applied to regulating physician supply."

"The debate over health reform under way in and outside Congress highlights how physician supply is connected to the more macro policy objectives of universal access to care and cost control," Ricketts said. "If access is expanded through subsidy to health insurance, the demand for physician services will increase potentially beyond what is available. If physician supply is in excess of what the market will bear, the prices of those services may increase to unsustainable levels."

Developing better state level data collection and reporting mechanisms could help make physician counts more accurate, he said, especially if they are linked to a central registry overseen by the Federation of State Medical Boards.

"The physician work force is one of the most critical factors that must be considered in current health care reform efforts and discussions," Ricketts writes. "Having accurate estimates for determining not only the number of physicians but also current and future physician work force requirements and capabilities for delivering primary and specialty care will be essential for achieving and sustaining effective health care reform."