Nationally, too, the reports find the greatest shortage away from urban centers and in certain specialties. "General surgery in rural areas is becoming a national disaster," said Dr. Richard A. Cooper, a former medical school dean who is now professor of health economics at the University of Pennsylvania.
What is needed, he said, is a national push to expand medical schools to add more residency slots. The country is now training about 25,000 doctors a year, he said, and needs to train 10,000 more than that within 20 years.
But researchers such as Baicker of Harvard argue that there's no clear evidence that more physicians make people healthier. Baicker was co-author of a 2004 study in the journal Health Affairs, using Medicare data, which concluded that states with high proportions of medical specialists scored worse on measures of quality care.
"It's hard to know for sure how many doctors we need," she said.
The Maryland study projected physician need by looking at the state's population by age and calculating how much care would be needed, based on national benchmarks, said David Boucher, a partner in Boucher and Associates, the Syracuse, N.Y., firm that crunched the numbers. The national doctor supply figures aren't calculated the same way, the study's sponsors said, so the comparisons might not be exact.
Jonathan Weiner, professor of health policy and management at the Johns Hopkins School of Public Health, said warnings a decade ago about an oversupply of physicians - he was one of those issuing the warnings - led to a capping of medical school and residency slots.
Although there might be about the right number of doctors overall, he said, "I definitely agree we have real challenges of access, particularly in rural and inner-city areas."
He said policy fixes should be targeted to areas of greatest need; it makes no sense "to give the same subsidy to a plastic surgeon in Potomac that we do to an inner-city primary-care doc."
bill.salganik@baltsun.com
