LABORATORIES AND THE HEALTH-CARE MARKETPLACE - THE LIMITS OF STATE WORKFORCE POLICY

Nearly every state has enacted its own effort to change both the compo sition and the practice patterns of America's medical workforce. At th e same time, the health care marketplace is altering the nation's medi cal workforce, encouraging more medical students to enter primary care and fewer to become specialists. In this article, I consider various issues raised by these trends. Do the various state programs constitut e an effective policy laboratory? Is the market solving problems gover nment could not? Are the government initiatives now irrelevant? I conc lude that the market is solving the problem of specialty maldistributi on (too many specialists) but not the problem of geographic maldistrib ution (too many medically underserved communities). I also conclude th at state workforce efforts have not constituted good policy laboratori es and that only federal action can seriously address the geographic m aldistribution problem.