Do we need more doctors?

Universities in England have recently been invited to bid for additional medical student numbers from 2006, and consider increasing numbers further from 2008.1 Do we need more doctors, or are there alternatives to expansion of medical education? BACKGROUND Since before the creation of the National Health Service, governments have planned the labour market for doctors, forecasting their demand and supply and adjusting medical school intake. A regular cycle of ‘shortages ’ and ‘surpluses’ have been forecast, with little changing methods, despite regular critiques over 30 years.2–5 Medical school intake appears to have been guided largely by political forces; either to create more NHS activity, or to control public expenditure. The implicit assumption is that the average level of activity per doctor is constant, so overall activity can only be affected by adjusting the size of the workforce. This limits the potential for change without the time lag of medical training, and neglects the role of financial and non-financial incentives in influencing overall activity and reducing variations in practice. Figure 1 shows a time trend of UK medical school intake, illustrating a gradual increase since the 1960s, with a