Work force planning requires looking at both the number and distribution of physicians

LETTER — Posted March 8, 2004

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Regarding "Medicare law aims to bring Alaska physicians in from the cold" (Article, Jan. 19) and "Evaluating the need for more doctors" (Editorial, Jan. 19):

In the mid-1990s I was an active participant in the AMA Young Physicians Section. Back then, we kept hearing about an imminent glut of physicians -- specialists in particular -- and the need for more primary care doctors to offset this problem.

All along I maintained the problem was maldistribution of specialists to the larger urban settings. Meanwhile, I've observed the use of increasing numbers of physician extenders to the point where "clinician" is used to describe almost anyone directly involved in patient care.

Your article on Alaskan physician work force issues reminds me of when I was stationed at Elmendorf Air Force Base as an Air Force psychiatrist; I was one of those on-base docs available to see military and retired family members. I am saddened to read about their transfer to a less-familiar care system as much as I'm dismayed at the dwindling numbers of military specialist physicians. Sacrificing the needs of the very young and the elderly is a common way to "improve programs" while diminishing service.

Raymond M. Reyes, MD, Fairfield, Calif.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/03/08/edlt0308.htm.

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