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David C. Goodman, MD, MS; Elliott S. Fisher, MD, MPH; Thomas A. Bubolz, PhD; Jack E. Mohr; James F. Poage, PhD; John E. Wennberg, MD, MPH
Dartmouth Medical School Hanover, NH

JAMA. 1997;277(12):965-966.

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In Reply.

—We believe Dr Floch may have misread our article. We studied the physician workforce across the 306 hospital referral regions of the United States. Three health care systems, a large HMO and 2 regions, were selected as benchmarks to point out that modest physician workforce levels are consistent with health care systems successfully competing for patients in the marketplace. Floch may prefer a different benchmark with a greater workforce, and we would encourage him to investigate the marginal benefits of these additional physicians to the region. However, the epidemiologic analysis of the distribution of medical care resources, including physicians, is a well-established research area within health services research. As with any area of research, investigators may differ in their interpretation of data. In the instance of the specialty workforce, the conclusion that there are too many specialists in many regions of the United States is shared by the Institute of . . . [Full Text PDF of this Article]

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