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Are We Training Too Many Subspecialists?-Reply

William B. Schwartz, MD; Albert P. Williams, PhD; Joseph P. Newhouse, PhD; Christina J. Witsberger, MPH
JAMA. 1988;259(18):2698. doi:10.1001/jama.1988.03720180025025.
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In Reply.  —Drs Mitchell and Schroeder have ignored the fact that our key conclusions are based on the distribution of board-certified subspecialists in all 50 states (Table 1 in our article). Instead, they refer only to our observations from 23 states on physicians who simply designate themselves as subspecialists; even the findings from those states can be generalized to the entire United States because the distribution of board-certified subspecialists in the 23-state sample is similar to that in all 50 states.In a further criticism, Drs Mitchell and Schroeder assume that physicians are maldistributed and then argue that such maldistribution is little affected by the growth in physician supply. But, contrary to their premise, the higher physician-to-population ratio in metropolitan areas cannot be taken as evidence of maldistribution. As we have noted elsewhere, demand in cities is higher for a variety of reasons, including the extensive amount of care sought


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