To the Editor: Where is the evidence for the claim by Joyce, McNeil and Stoelwinder1 that there was a boom in medical workforce supply in the 1970s?

They are perpetuating the accepted macroeconomic myth of there having been a surplus at that time. The microeconomic, marketplace truth was that there was a shortage of general practitioners throughout the 1970s.2 This was so severe that, after battling for some years after 1974 to find a partner for my suburban Sydney practice, I resorted to advertising overseas, finally importing an overseas-trained graduate.

It is time for this myth to be laid to rest. There has been a marketplace shortage of GPs since the early 1970s.

The truth is that federal governments have baulked at the expansion of payments through Medibank/Medicare. Rather than apply any controls on demand, they have obstinately rationed supply, repeatedly citing dubious statistics and invalid international comparisons to justify a diminution in the supply of GPs.

In reply: Our reference to a boom in medical workforce supply during the 1970s was based on the marked increase in medical workforce entries in that decade. The number of Australian medical graduates rose from 851 in 1970 to 1278 in 1980.1,2 In contrast — and as a result of a shift to a policy of constraint — graduate numbers remained quite static during the 1980s and 1990s, at around 1200–1300 per year (Commonwealth Department of Education, Science and Training custom datasets RFI 03-312, RFI 04-360, 2004).

Although the policy shift in the 1980s was based on a perception of surplus, judgements about workforce adequacy were contentious at that time and remain so. We did not intend to imply necessarily that there was a surplus in the medical workforce (or the general practice workforce specifically) during the 1970s. Rather, our historical reference was intended to show the parallels with the large influx that will result from current expansion in medical school intakes, and to highlight the cyclic nature of both medical workforce policy and perceptions of adequacy. We agree with Arnold’s implication that policies which attempt simply to adjust gross supply (up or down) are insufficient to ensure an adequate medical workforce.