The Rudd government's plan for an extra $600 million to train hundreds of GPs and specialists raises the broader question of whether having more doctors will give us better, more efficient health care.

Not necessarily, according to a landmark Harvard Business Review paper published in 2002, which identified a downward shift in knowledge and technology as critical to containing health costs.

This downshift refers not to corporate types moving to idyllic rural towns to grow organic vegetables but to less skilled practitioners being adequately equipped with knowledge and technology to allow them to take on more complex roles.

It is happening already. A host of drugs that used to require a prescription are now available over the counter, allowing patients to administer their own care. Nurse practitioners are capable of treating many ailments that used to require a physician. And relatively new procedures, such as angioplasty, allow cardiologists to do what would have required the services of an open-heart surgeon.

The Productivity Commission echoed these ideas in its report in 2006, Australia's Health Workforce, which tentatively identified the importance of ''task substitution'', a dirty phrase in the upper tiers of health providers meaning to allow a particular task to be performed by someone holding lesser qualifications.

In spite of the angst about medical training, the reality is medical schools and postgraduate training programs churn out specialists and subspecialists with extraordinary skills, but often those skills are not what the community needs.

Not being market driven, medical training has overshot the needs of its customers. It addresses the needs of a relatively small population of very sick people. In part, it does so because the cheaper labour of training doctors subsidises underfunded public hospitals.

But spending millions of dollars on highly trained workers out of tune with the needs of the population does not make sense.

The private sector provides a great opportunity for training specialists but is vastly underutilised. It is where the most common ailments are treated. For example, orthopaedic surgeons spend years dealing with complex trauma in public hospitals, only to find themselves dealing with simple things such as bunions and fractured ankles when they complete their training.

The modern specialist is like a fireman waiting for the call to an inferno, only to spend long days pulling cats out of trees in the wait.

This is interspersed with incurable and intractable problems for which they trial novel and experimental treatments.

Trained in the rare and complex, much of practice is consumed in excluding the rare and complex. It is no wonder new technologies account for a third of the increase in health spending in the past decade.

The recent controversy about CT scans relates to this trend. British doctors are amazed at the ease with which expensive scans can be ordered in Australia. Britain's National Health Service controls them more strictly. As in many arenas, we lie somewhere between British prudence and US excess.

Much of it is consumer driven. An aggressively consumerist society will breed defensive consumerist physicians. So rather than continuing to ask expensive, specialised professionals to move downmarket, we need to focus on enabling less expensive professionals to do progressively more sophisticated things in less expensive settings.

Our health system and the ensuing doctor shortage is built on a flawed rationale - that highly trained people are required to diagnose all the varieties of illness. The same logic was used to resist other transformative technologies, including the personal computer.

This is despite the fact physicians use only a fraction of their training and knowledge in the vast majority of their encounters.

Health economics is based on the idea of information asymmetry. The gap in knowledge between doctors and patients is vast. The power differential demands a host of regulations.

Modern communications has diluted this gap. If the printing press brought the Catholic Church down a notch, the internet has taken one off traditional professions such as law and medicine.

Democratisation of knowledge has not disrupted the industry in the more fundamental ways necessary. As attempted reform in the US has shown, entrenched interests are not easily shifted and rational debate in a sector overlapping with themes of life and death is difficult.

But health costs threaten to hold Western governments to ransom. As health shapes to become one of the battlegrounds in this year's federal election, the sector's resistance to painful change is unlikely to be challenged.

Tanveer Ahmed is a psychiatry registrar at St John of God Private Hospital, Burwood.