The Physician “Surplus” and the Decline of Professional Dominance

Abstract

��� Two immediate circumstances cast a shadow over [physicians, voluntary hospitals, and medical schools’] future: the rapidly increasing supply of physicians and the continued search by government and employers for control over the growth of medical expenditures. —Paul Starr, The Social Transformation of American Medicine (emphasis added) This essay examines the relationship that Paul Starr hypothesized in The Social Tranformation of American Medicine (1982) between the supply of physicians (both allopaths and osteopaths) and their professional dominance, a relationship, he argued, that began to turn negative about the time of the passage of Medicaid and Medicare in 1965. In particular, Starr posited that an increasing number of physicians, dubbed a “surplus,” would become an essential condition in reducing their dominance over the health care system, while abetting the larger process of corporatization that the medical profession was experiencing (421‐427). In the pages that follow, I first outline the main points of Starr’s argument, one that was also accepted by many others (Mick 1980). Second, I discuss how and why growth in physician supply has not contributed as much as was predicted to a putative decline in medicine’s privileged professional status. Finally, I propose that whether physician supply is in surplus (or shortage) is a