Matt Yglesias at Think Progress took a look at some OECD data comparing U.S. physicians to their international counterparts and concluded we need more doctors. The evidence? There’s only 2.4 practicing physicians per 1,000 population in the U.S., second lowest in the OECD and somewhat below the 3.0 median (the range is from 2.2 physicians per 1,000 population in Japan to 4.0 in Norway). At the same time, the average U.S. medical consumer sees a physician only 3.9 times a year compared to the 6.3 OECD median. Yes, we pay a lot for health services including physician services (he reprints a chart showing average pay for U.S. physicians, whether highly paid orthopedic surgeons or relatively poorly paid primary care docs, that shows they are the highest paid among six well-off OECD countries). But his conclusion that America therefore needs more docs is off the mark.
This is a classic case where picking out a few trees as signposts in a dense forest of data leads one down the wrong path. His own charts show that the relatively small population of Japanese physicians enables that country’s general population to see a physician a stunning 13.2 times a year, twice the OECD average. One gets an image of a team of six doctors greeting every patient who walks in the door. Actually, that isn’t far from wrong. During my most recent visit to Japan, I visited a community clinic in Kumamoto Prefecture on Kyushu that gives local citizens their annual wellness exam, which is reimbursed under their national health care system. Every person is given a day off work to get this exam. At the clinic, the patients moved from room to room. At each stop over the course of a day, they were examined by different physicians and technicians who specialized in various aspects of personal health. A small number of doctors. A high level of primary preventive care with many hands-on encounters. Few visits to high-priced surgeons. Low overall health care costs.
As a personal aside. Who cares how many times I see a doctor each year? My own preferred number is zero, although I put up with one because I’m at an age where my wife insists I really ought to get an annual physical exam.
The real issue lies in the physician pay, which Matt Y. touches on but draws the wrong conclusion. He forgot to pull the crucial statistic: the distribution of doctors among specialties in U.S. and their relative pay. Here’s data from the Bureau of Labor Statistics annual occupational employment survey:
If you look over that data carefully, you’ll see that there are nearly as many anesthesiologists and surgeons (78,050) as there are family and general practitioners (97,820). The median salary for the former group (which most people only see once in any given year, unless they’re unlucky or very, very sick) is about $50,000 higher than the latter group. As has been reported many, many times by the Dartmouth Atlas of Health folks, we have a severe over-utilization problem in the U.S., driven in large part by the U.S.’s very high rates of coronary interventions, urological surgeries, and orthopedic surgeries (artificial knees, hips and backs).
Imagine getting rid of, say, 30 percent of those unnecessary surgeries (this again is the Dartmouth derived number for their estimate of over-utilization in the U.S.). This could, of course, lead to about one-third fewer surgeons without generating long queues for their services. But rather than laying them all off (ha!), imagine they were magically transformed (perhaps a local medical school could set up a retraining program) into general practitioners who would see and manage patients in Accountable Care Organizations (and who would properly oversee patients with chronic conditions so they could avoid needless surgery). You would then have the same number of doctors, more patient visits, and save billions annually in reduced physician salaries (they’d be earning at the median about $50,000 a year less).
Or, you could take the $50,000 per year saved from the one-third of surgeons who lost their jobs and end the “doc fix” problem on Capitol Hill. Or, you could provide new slots for just-out-of-med school general practitioners. In other words, you’d have more docs or higher paid (general practitioner) docs, or a mix of those two approaches without increasing overall health care costs.
Do we need more docs? Of a certain kind, yes. But overall? In my view, absolutely not.
Merrill Goozner has been writing about economics and health care for many years. The former chief economics correspondent for the Chicago Tribune, Merrill has written for a long list of publications including the New York Times, The American Prospect, The Washington Post and The Fiscal Times. You can read more pieces by him at GoozNews, where this post first appeared.