Nearly every state has enacted its own effort to change both the composition and the practice patterns of America’s medical workforce. At the same time, the health care marketplace is altering the nation’s medical 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 constitute an effective policy laboratory? Is the market solving problems government could not? Are the government initiatives now irrelevant? I conclude that the market is solving the problem of specialty maldistribution (too many specialists) but not the problem of geographic maldistribution (too many medically underserved communities). I also conclude that state workforce efforts have not constituted good policy laboratories and that only federal action can seriously address the geographic maldistribution problem.

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