What were they thinking? Over the previous decade, predictions were rampant that we were facing a surplus of physicians, especially specialists. But today, most specialties in internal medicine have a shortage. At the same time, I believe we will soon hear much about the shortage of generalists. Finding a doctor isn't easy. And many doctors are cutting back or even leaving practice.

Last week the Indianopolis Star published an article about the current cardiology shortage - Need for cardiologists is far outpacing supply. What is going on? How did we not understand the needs?

Several factors contribute to the growing shortage. Our population is aging, and we do a better job treating them. They live longer, and have more medical needs. Medical science remarkably advances care rapidly. When I was a houseofficer ('75-'78), we had two drugs for congestive heart failure - digoxin and furosemide. Actually, as a senior resident we started adding hydralazine. We had no ACE inhibitors or beta blockers. Even when we had beta blockers, they were contraindicated in CHF. Class IV CHF had a 50% mortality rate at 6 months. We could really prevent CHF.

Today we prevent much CHF. Patients with CHF live much longer. Patients with coronary artery disease live a long time, having many procedures, tests and hospitalizations. Our success in prolonging often good quality life comes at a cost. And much of that cost relates to needing more cardiologists.

Another reason for the growing shortages stems from the goals of our trainees. Life style issues are more important to the current generation of trainees than they were in the '70s. With the dramatic increase in female physicians, we have more physicians working shorter hours. This accentuates our need for more physicians.

I certainly haven't covered all the reasons in this short rant. Bottom line, the pundits blew it. We need more doctors, now and will need even more. We are getting better at treating patients, but our success does demand more care (i.e., more doctors). Reimbursement makes the challenge even greater. We are consigned to the famous Chinese curse, "May you live in interesting times.".