Does the United States have enough physicians?-Yes.For decades, experts have bemoaned a lack of sufficient primary care physicians in the United States. These fears came to a head during debate over the Affordable Care Act (ACA), when critics suggested that the millions of US residents gaining coverage under the ACA would further exacerbate the existing physician shortage. A 2011 American College of Surgeons report asserted that "even before [this] health care reform, the nation was headed for serious physician shortages and reform has only made it worse." 1 According to the updated report of the Association of American Medical Colleges (AAMC), released March 14, 2017, the AAMC still predicts a shortage of between 40 800 to 104 900 physicians by 2030. 2 Some have questioned the accuracy of these projections. Yet the ominous forecast of a physician shortage has already motivated significant reforms. During the last 15 years, the number of medical schools in the United States-including those with provisional or preliminary accreditations-has increased from 125 to 145. Concomitantly,medicalschoolenrollmenthasincreasedfrom16 488 to 21 030 students, an increase of 28% since 2002, and is expected to increase even further by 2018. 3 Additionally, over the last 5 years, the number of Accreditation Council for Graduate Medical Education programs has increased from 9022 to 9977, an increase of 10.6%, and the number of active residents (currently enrolled in a program) has increased from 115 293 to 124 409, an increase of 7.9%. 4 Since passage of the ACA, 22 million US residents have gained health care coverage and thousands of newly trained physicians have begun practicing. 5 Given these changes, it is worth reassessing the data on whether a physician shortage really exists.

IMPORTANCEThe average health outcomes in the US are not as good as the average health outcomes in other developed countries. However, whether high-income US citizens have better health outcomes than average individuals in other developed countries is unknown. OBJECTIVE To assess whether the health outcomes of White US citizens living in the 1% and 5% richest counties (hereafter referred to as privileged White US citizens) are better than the health outcomes of average residents in other developed countries. DESIGN, SETTING, AND PARTICIPANTSThis comparative effectiveness study, conducted from January 1, 2013, to December 31, 2015, identified White US citizens living in the 1% (n = 32) and 5% (n = 157) highest-income counties in the US and measured the following 6 health outcomes associated with health care interventions: infant and maternal mortality, colon and breast cancer, childhood acute lymphocytic leukemia, and acute myocardial infarction. The study used Organisation for Economic Co-operation and Development data, CONCORD-3 cancer data, and Medicare data to compare their outcomes with all residents in 12 other developed countries: Australia,

for errors of language and a percentage in the Australia section.

Everyone wants the best physician. Patients want their physician to know medical information by heart, to possess diagnostic acumen, and to be well-versed in the latest tests and treatments. Finding the best physicians often involves looking for resumes with stellar attributes, such as having graduated at the top of a collegiate class, attended the best medical schools, completed internships and residency training at the nation's most prestigious hospitals, and been awarded the most competitive fellowships. Many medical schools, likewise, want only the smartest students, as assessed by the highest grade point averages and MCAT scores.This selection process has persisted for decades. But is it misguided? Do the smartest students, as measured by science grades and standardized test results, truly make the best physicians?