WASHINGTON, D.C.: A new study claims that the United States has too many doctors, and points to a sharp increase in the presence of physicians trained outside the United States as the cause of the surplus. The report from the Institute of Medicine says that the ratio of doctors per 100,000 people increased 62 percent from 1970 to 1992, while the number of foreign-trained medical graduates increased 80 percent from 1988 to 1993. For the same period, the number of U.S. medical school graduates remained steady at 17,500. "The debate about a possible oversupply of physicians masks a bitter labor controversy in the medical community," notes Health reporter Janice Castro. "Managed care firms hire many doctors trained in other countries, for one thing, in part because they are often more willing to work for less, and accept tough rules governing the way they care for patients. So do underfunded public hospitals. The reason: doctors trained in other countries often have a very hard time establishing successful private practices, which depend largely on approving word of mouth among patients, who are often more comfortable with an American doctor. As managed care extends its control over the choices patients make, U.S.-trained physicians feel that they are being underbid by the doctors from other countries. In the end, it is not simply a question of whether we have too many doctors in this country, but whether we have enough doctors in the right places. Most physicians prefer to practice in urban areas. Private practice physicians feel the big health plans are locking them out of their own markets, and driving down their incomes. Meanwhile, many people in tiny towns and rural areas cannot find a doctor nearby when they need help."