Medical researchers have questioned the need for the training of more doctors in the UK, challenging one of the government's key policies.
"Medical school intake has increased by 50% in the last six years," said Karen Bloor of York University.
She added: "It seems extremely hasty to increase the number of students further before these doctors are even fully trained and in the NHS workforce. "There are real questions about the appropriate number of doctors in the NHS, and research could inform these questions. But in practice, decisions to increase doctor numbers often reflect political expediency rather than better management of doctor activity in the healthcare system," Dr Bloor said.
Writing in the Journal of the Royal Society of Medicine, Dr Bloor, Vivien Hendry and Alan Maynard examine whether more doctors would improve patient health in the UK.
It follows the Higher Education Funding Council for England's call for universities to bid for additional medical student numbers from 2006 and again in 2008, and coincides with the currently ongoing workforce planning inquiry of the Commons health select committee.
The UK has fewer doctors per head of population than the US and all western European countries but the authors question whether expansion of medical school numbers would necessarily improve healthcare. They question whether other staff like nurses and radiographers could be substituted more for doctors and so save money.
Their paper argues that medical workforce planning remains dominated by issues that are poorly managed and measured. The time lag between expanding medical school intake and producing fully trained doctors creates uncertainty and risk, they say.
Expansion of the medical workforce does not necessarily result in an efficient or equitable distribution of doctors, geographically or in terms of specialty, say Dr Bloor and her colleagues.
They suggest that one solution for the unequal distribution of doctors will be created by rising levels of debt among medical students. Graduates could be directed into less popular areas by scholarships or debt repayment schemes, as already happens in the US.
The paper warns that expansion may create substantial expenditure inflation that will be extremely difficult to reverse. "We cannot look at the medical workforce in isolation from other health issues, including financial constraints" said Dr Bloor.
"The evidence suggests some scope for substitution and complementarity of staff roles. The NHS is increasingly using nurse practitioners and other health professionals are substituting for doctors, like radiographers for radiologists. The implications of this for healthcare workforce planning should be further explored," she added.
