COMMENTARY Does Having More Physicians Lead to Better Health System Performance?

THE US HEALTH SYSTEM FACES ONGOING CHALLENGESin addressing its shortcomings in access and qual-ity.1 Against a foreground of uneven and frag-mented care lies a bleak background of unrelent-ingly accelerating costs. Although the problems of quality and costs are long-standing, several organizations have re-cently asserted that there is a new impending health care “tragedy”2: the physician workforce shortage. In contrast to the extensively documented problems of quality and afford-ability, the inference of a physician shortage rests on a less robust set of analyses. Assertions of a physician shortagewar-rant a critical examination becausemore physicianswill com-pete for new resources against already well-documented health system needs. From Surplus to Shortage Ten years ago, the consensus was that there were too many physicians, particularly specialists, in the United States. In the 1990s, the Council on Graduate Medical Educatio