Back when Hillary Rodham Clinton tried to prescribe a cure for what ails the health-care system, she proposed holding down medical costs by limiting the number of openings in medical schools for specialists. Why? Because specialists generally command much greater fees than general practitioners.
Noting that 85 percent of medical students were aiming at specialties, against 15 percent who wanted to be G.P.s, the First Lady opined: "We have to make a decision as a country to reverse that."Well, that's precisely what "we" have done - though not through government fiat and bureaucratic policing but via the free marketplace.
In just three years, Scripps Howard News Service reports, the percentage of young doctors leaning toward careers in general practice has doubled to about 28 percent. The reason is fairly simple: To contain costs, insurance companies are pushing plans - HMOs, managed-choice schemes and so on - that require patients to see a primary-care physician before visiting a specialist. So there is a demand for more "stage one" doctors, whose pay is rising enough to make the field attractive to young internists.
Moreover, some medical specialties are glutted - just as would be expected. When, for example, a G.P. diagnoses urinary pain as an infection and treats it with a prescription, there's less work for the urologist with his or her battery of esoteric tests. Cough syrup is cheaper than a chest X-ray, and the advice to fight depression by exercising costs less than a few hours on the psychotherapist's couch.
In all fairness, Hillary Clinton deserves some credit for focusing public attention on the issue. When she and the 500 members of her health-care reform task force talked about capping medical school specialty slots, some schools stopped treating G.P. courses like medicine's ugly stepchild. In 1990, no foundation money funded primary-care courses; today, 50 schools are getting such grants.
Meanwhile, rapid advances in medical science mean a big and continuing demand for specialists. Let's all be grateful for that - and for the fact that federal patent medicine has not replaced the medicine of the free marketplace.