If Primary-Care Doctors Were Taxed Like Hedge-Fund ManagersBy UWE E. REINHARDT
Uwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in the health care field.
"Advancing Primary Care" was the sole focus of the latest report by the Council on Graduate Medical Education, whose mandate is to assess the current and future health work-force situation and make recommendations to the federal government. The problem has long been how to get this done.
To entice a higher than the current fraction of medical-school graduates into primary-care practice requires a solid understanding what factors influence the choice of a medical specialty as a career.
Among the nonpecuniary factors that have been identified are the medical students' personal characteristics, their socioeconomic background, whether they grew up in rural or urban settings, the professional prestige that faculty advisers and society at large appear to accord different specialties and, of increasing importance in recent years, the life styles that different specialties imply - that is, the leisure time available for family and personal control over work hours.
It is difficult, perhaps even impossible, to manipulate these nonpecuniary factors significantly through public policy. Much easier to manipulate are the purely economic prospects implied by the choice of a specialty - that is, the rate of return on their investment in medical education that medical students can expect from practice in different specialties. Along with prospective life style, that economic dimension of specialty choice has been found to be influential.