Too many doctors?

What would be the typical government reaction to a health care crisis? More doctors, of course. Shannon Brownlee questions this, at least for the US. Unlike the number of car dealers, for instance,

which depends on the number of people who want cars and can afford them ...how much health care patients want or need has far less influence over the supply of physicians. That’s because for the most part it’s your doctor and not you, the consumer, who determines how much care you receive. When your doctor says you need a CT scan, you get one. When your doctor says you should go to the hospital, you go. Doctors, in effect, generate some of the demand for their services, so that even when there are large numbers of them per capita, they can keep their appointment books full. Source

There's also the possibility that fewer doctors could lead to better care:

More tests and procedures always entail more risk, and for care that’s unnecessary, the ratio of benefit to risk is zero. What’s more, where numerous doctors, particularly specialists, are routinely involved in a patient’s case, the potential for miscommunication and confusion multiplies. Modern medicine should be a team sport, but it is often practiced as if everybody is running a different play. Different doctors order duplicative tests, prescribe drugs that interact poorly with what the patient is already taking, and assume another physician will attend to a critical aspect of a patient’s care. A cardiologist can be a virtuoso at slipping a stent into the coronary artery of a patient in the throes of a heart attack, but if she leaves it to another physician to prescribe aspirin to her patient -- one of the most effective treatments for preventing a second heart attack -- that prescription might fall through the cracks.

This is what appears to be happening in many hospitals, where the ratio of specialists to primary-care physicians is especially high. In one recent study, two Harvard economists ... examined how the quality of care in different states varied as the proportion of specialists rose. They found that measures of quality, like the percentage of heart-attack patients who received a prescription for aspirin, tended to fall in direct proportion to a rising ratio of specialists. The point ... “is not that the specialist is inferior, but that the system is not accounting for the ‘coordination cost’ specialists are imposing.”

This is worrying because the likely policy response is going to create more such problems. How could a politician, even one convinced by solid research proving Ms Brownlee's points, cut back training programmes for doctors? How would it look to his or her political opponents, or to the media, when a medical mistake occurs at a hospital that would have had more doctors but for our politician's cutbacks? It's not just health care. In every policy area the penalties for doing something likely to succeed but different far outweigh the benefits for doing something that has been tried before and shown to fail. Rising crime? Spend more on police or CCTV cameras. Traffic congestion? Build more roads. Not enough fish being landed? Subsidize more powerful fishing boats. The incentives are to placate lobby groups and vested interests, not to achieve society's goals.