Much of the way our profession evolves seems to be excessively influenced by reaction to economic forces rather than proactive planning with sufficient input from the perspectives of all appropriate stakeholders. Such is the case with workforce planning in medicine. No doubt, economic forces are the principal factors that influence how we should plan because resources should be allocated commensurate with value. However, this mentality assumes we have a rational system that closely links financing with value. We do not have such a system. In the meantime, I wonder whether we can do better in planning our workforce and practice patterns rather than reacting in a manner so dependent on economic winds. Take, for example, the emerging practice of comanagement of surgical patients by internists.
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