The World Health Organization estimates a current global shortage of 4.3 million health workers. Australia and New Zealand compare unfavourably with other Organisation for Economic Co-operation and Development (OECD) countries in respect to doctor numbers. The overall shortage of doctors in Australia and New Zealand is exaggerated by the disciplinary, cultural and demographic maldistribution of the doctors relative to need and utility. Australia and New Zealand are the most reliant of the OECD countries on foreign doctors. An increase in spending on health promotion and disease prevention is essential. However, it is unlikely that the demand for doctors will be significantly reduced by compressions of morbidity in the later years of life or that there will be a substantive increase in either the percentage of the community employed in health services or in the output from the current workforce. Doctor shortages are better addressed by alignment of elements of the education and health systems with each other and with patient care needs, and by innovative health provider training and employment.