Are There Too Many Specialists?

by Tera Tuten on July 1, 2014

Soliant-Are-there-too-many-specialistsWith a projected shortage of 45,000-90,000 primary care doctors by the year 2020, it’s no wonder we’re worried these days about whether there are (or will be) enough MDs for primary care.

So are there too many specialists in the U.S.? Here’s a look at both sides of the coin:

There are too many specialistsSoliant-Are-there-too-many-specialists2

Among the 34 member countries of the Organization for Economic Co-operation and Development (OECD),  the U.S. ranks first (by far) in the ratio of specialist-physicians-to-primary-care-practitioners.

While many experts believe that an ideal health care system consists of 70% primary care doctors (including interns, family physicians and pediatricians) and 30% specialists, the U.S. system is exactly the opposite, with more than 70% of U.S. doctors working as specialists.

It seems like we need a lot more primary care doctors, but plans to try and create more primary care slots in med schools may not be the answer.

Many of the same pundits that argue that there are too many specialists in the U.S. also point out that the lure of higher paychecks will continue to funnel more specialists into the system – a system that doesn’t run on a traditional system of supply-and-demand.

Demand for specialist MDs is typically driven by recommendations for appointments, tests, surgeries and other procedures – and rightfully-so, as long as all are truly necessary.

There aren’t too many specialistsSoliant-Are-there-too-many-specialists3

Many specialists also do some amount of primary care – whether or not they intend to.

This is especially true of patients who initially come to such MDs for specialized treatment who then end up receiving care for ailments that are, strictly speaking, actually in the realm of family doctors and the like.

Because we don’t have any widely agreed upon way to know how many practicing physicians there are in the U.S. (check it out for yourself), there’s no accurate way to know – beyond anecdotal evidence – if we have enough MDs. Even the difference between estimates can vary more than 20%.

Add to that the fact that not all licensed MDs in America are practicing MDs: It’s not known how many, how many of those consider themselves specialists vs primary care doctors, and how many hours doctors in-practice actually put in (beyond Labor Bureau averages.)

In a June 2013 edition of the Journal of the American Medical Association (JAMA), Indiana University School of Medicine Health Policy Vice Chair Aaron E. Carroll suggests “The United States doesn’t have too many specialists compared with other countries. It has a rather average number of specialists.”

How to get more primary care MDs

While we may have a primary care shortage, few would claim that we have an overall physician shortage. (The danger, then, is that attempts to create more primary care doctors by just increasing spaces in med schools may just add even more specialists to the system when it comes time for graduating students to choose a specialty).

Assuming there is a current and future demand for more family and other primary care doctors (whether or not there really are more specialists than the country needs), the answer to all this may lie in taking the financial sting off of choosing primary care over more lucrative specialties that can pay off med-school debt faster.

While the cost of a four-year medical degree in the U.S. is about a quarter of a million dollars, such an education in Canada costs $75,000…and in France? $10,000

A 2011 New York Times op-ed says the answer is “free medical school tuition,” but also “subsidizing primary care training, and withdrawing training stipends for specialists”…basically, charging doctors who want to specialize.

It’s a controversial way to try and balance perceived shortcomings in the system, assuming it’s a system that truly has shortcoming in such desperate need of balancing in the first place.


Do American medical specialists really make too much money?

Too Few Generalist Physicians Doesn’t Necessarily Mean Too Many Specialists

Why Medical School Should Be Free?

Too Many Doctors, But Too Few Primary Care Ones

Doctor Debate: Too Many American Physicians Or Too Few?


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