The Doctor Deficit

The demand for health care is rising faster than the supply--that has long been obvious. Now the dimensions of the gap have been measured, and found to be immense, by a leading South African medical educator. In a book to be published this week in time for the Ottawa meeting of the World Medical Association, Professor Isador Gordon of the University of Natal concludes that present efforts to meet the crisis merely by training more doctors are likely to fail.

Titled World Health Manpower Shortage: 1971-2000, Gordon's report is probably the most exhaustive inventory of global health resources ever undertaken. It is also the most depressing, for it shows that most nations in Asia, Africa and Latin America are capable of providing health care for only a minuscule fraction of their populations. Indonesia, for example, has just one doctor for every 28,000 people. The African continent, which increased its medical manpower by 2% between 1960 and 1967, still has but one physician for every 9,700 individuals. Southeast Asia has a ratio of one to 5,960.

Unemployed Physicians. Nor are the countries that have begun to industrialize able to provide care for all segments of their population. India has one doctor for every 5,112 people, but this figure is misleading. Indian doctors tend to congregate in the cities and leave rural sections of the country uncovered. Despite India's need, there are 20,000 qualified but unemployed physicians in the country. They lack the funds to establish private practices, and public facilities are too few to employ them all. Their only hope is to get hospital appointments--usually in the cities--or to emigrate. Each year, 10% of India's new medical graduates leave the country to practice elsewhere.

Japan, for all its prosperity, musters only one doctor for 880 people, and there are at least 2,900 muison, or doctorless villages. Even in the U.S., where there is one doctor for every 650 individuals, there are entire counties without a single physician.

Soviet Approach. Most countries are trying to solve the problem by training more doctors. But, says Gordon, such efforts are both inadequate and impractical; population is increasing faster than doctors can be educated. Therefore Gordon supports the approach that has already been tried and found successful in the Soviet Union--the use of feldshers, or medical assistants, to take over many of the doctors' less demanding duties. He believes that such workers are essential to provide basic medical care in doctor-short areas and also to increase the productivity of regular physicians.

Several countries of varying medical affluence apparently agree. The government of Cameroun has established a health institute in Yaounde to train a variety of nonprofessional practitioners. The U.S. Government is also interested in the idea. It is sponsoring programs to use former military corpsmen as Medex, or physicians' assistants, and has already put several to work in doctors' offices in the Pacific Northwest.

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