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Itzhak Jacoby, PhD; Gregg S. Meyer, MD, MSc

JAMA. 1998;280:822-824.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The rapid evolution of the health care system has brought enhanced cost consciousness, curricular reform for practicing in the managed care setting, and an increased focus on the economics of care delivery.¹ The latest challenge entails building a more functional market for physician services. Positive activity in this direction has already begun, but there are also serious impediments.

First, the US physician workforce has one of the largest physician-to-population ratios in the world²; this supply will remain dominant for decades, no matter what changes are made in medical education. In addition, the overall appeal of a career in medicine remains strong, with more than 2 applicants for every entering position in medical schools.³

Second, there are now nearly 2 medical specialists for every generalist.⁴ This large proportion of specialists has been blamed by payers and others for overusing medical technologies and . . . [Full Text of this Article]

From the Departments of Preventive Medicine and Biometrics (Drs Jacoby and Meyer) and Medicine (Dr Meyer), Uniformed Services University of the Health Sciences, Bethesda, Md. Dr Meyer is now director of the Center for Quality Measurement and Improvement, Agency for Health Care Policy and Research, Rockville, Md.

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