It was a chance encounter.
After all it’s not every day you see an internist who still frequents a hospital. We’ve known each other for years and he’s been watching the changes in health care, too.
“Boy, they’re really not happy Over There. Seems they’ve contracted with Big Boy insurance as part of their new ACO model. Everyone’s going to get their piece before the doctors: Over There hospital, their four million administrators, lawyers, grounds crews, parking staff…. Then, after everyone else is paid, the doctors might get a few scraps if there’s some left over. No guarantees. All risk, no certainty of reward. There was no way I could still go there. I joined them, but had to leave when I saw how unworkable that was.”
“Isn’t this our new way forward?” I asked.
“I guess so. Scary. But I’ve got just a few more years. Just have to get the kids through college.”
Continue reading “Things Are About to Get Interesting”
Filed Under: Uncategorized
Tagged: Dr. Wes, Physician Shortage
Jul 31, 2012
There are lots of losers in President Obama’s effort to remake the U.S. health care system, and chief among them are the doctors. But there are also winners, especially nurses and physician assistants (PAs). Indeed, nurses and PAs win big in part because doctors lose badly.
Surveys repeatedly show doctors are fed up with low reimbursement rates from Medicare and even lower from Medicaid, which have increasingly led doctors to no longer see new patients in those government-run plans. For example, a recent Texas Medical Association survey found that “34 percent of Texas doctors either limit the number of Medicare patients they accept or don’t accept any new Medicare patients.” Even more do not accept patients with Medicaid.
Then there’s the heavy-handed regulations and requirements from both government and private health insurers. Complying with all those requirements and paperwork creates expensive and time-consuming administrative burdens. And to top it off, there’s the looming shadow of a high-cost lawsuit if things don’t turn out well.
And that’s all before ObamaCare kicks in, which will exacerbate every one of those problems. So it’s little wonder that there are physician shortages, especially in lower-paying primary care, and those shortages are only going to get worse if ObamaCare succeeds in getting an estimated 32 million more Americans insured.
The increased demand for medical care and lower reimbursements—which is one of the primary ways ObamaCare will try to hold down costs—is a recipe for a mass exodus of doctors willing to practice medicine. As “Physicians Practice” reported in August from its physician survey: “Nineteen percent say they plan to move to another position in the same field. An equal amount says they plan to leave medicine—not to retire, but to pursue something new.”
Continue reading “Health Care Future Bright for Nurses. Stinks for Doctors.”
Filed Under: Physicians, THCB
Tagged: health care reform, Medicare reimbursement, Nurses, Nursing, Obamacare, physician assistants, Physician Shortage
Jul 14, 2012
Just over two years ago, President Barack Obama signed the Affordable Care Act (ACA), a law purported to increase access to health care and to “bend down” the health care cost curve. A great debate over the implications of that law, especially in the areas of coverage, affordability, and quality of care, has arisen. Furthermore, a series of political and legal challenges have generated uncertainty about the law’s prospects within the health industry and at the state level. Despite this, the Department of Health and Human Services (HHS) has already issued over 12,000 pages of regulations elaborating on the original 2,700-page law, leading to more uncertainty regarding how appointed and career federal officials will determine the exact shape of the law’s final requirements. All of this uncertainty raises real concerns about how the new law will impact the most crucial actors in any health care reform effort: doctors.
Doctors are demonstrably nervous about the new law and how it will affect their incomes, their access to technologies, and their professional autonomy. According to a survey by the Doctors Company, 60 percent of physicians are concerned that the new law will negatively impact patient care. Only 22 percent are optimistic about the law’s impact on patient care. Fifty-one percent feel that the law will negatively impact their relationships with patients. These statistics raise questions about how and whether doctors will participate in the new system.
Continue reading “How The Affordable Care Act Will Affect Doctors”
Filed Under: THCB
Tagged: Affordable Care Act, CMS, cost curve, Doctors Company, HHS, IPAB, Obama administration, Patient Care, Physician Shortage, reimbursement rates, SGR
Jun 15, 2012
As I noted last week, I get a little annoyed by the seemingly constant public complaints of physicians, coupled with threats to leave medicine and dire warnings that no one will want to be a doctor in the future. This is in spite of it still being one of the most trusted professions around, and one that is darn well compensated. So it’s nice to see that the general public hasn’t bought into this meme yet (from the AAMC 2011 Medical School Enrollment Survey):
- First-year medical school enrollment in 2016–2017 is projected to reach 21,376. This projection represents a 29.6% increase above first-year enrollment in 2002–2003 and comes close to reaching the 30% targeted increase by 2015 the AAMC called for in 2006.
- Of the projected 2002–2016 growth, 58% will be at the 125 medical schools that were accredited as of 2002. New schools since 2002 will experience 25% of the growth, and the balance (17%) will come from schools that are currently in LCME applicant- or candidate-school standing.
Continue reading “So it Turns Out that Lots and Lots of People Still Want to Be Doctors”
Filed Under: Superhealthanomics, THCB
Tagged: AAMC, Med, Medical Education, Medical School, Medical Students, Physician Shortage
May 3, 2012
As you can imagine, I spend a lot of time with physicians. As a group, they sure do like to complain. Yet, medical school applications are strong, and residency spots are still competitive. So I take cries of “they’re all going to quit” with a grain of salt.
That said, I also like data. So it’s worth checking in every once in a while to see what physicians, as a group, are thinking. There’s a study in the Journal of Primary Care and Community Health that does just that:
The status of the primary care workforce is a major health policy concern. It is affected not only by the specialty choices of young physicians but also by decisions of physicians to leave their practices. This study examines factors that may contribute to such decisions. We analyzed data from a 2009 Commonwealth Fund mail survey of American physicians in internal medicine, family or general practice, or pediatrics to examine characteristics associated with their plans to retire or leave their practice for other reasons in the next 5 years.
What did they find? More than half of physicians age 50 and over had plans to leave their practice in the next 5 years, or weren’t sure about staying in practice. No physicians age 35-49 had plans to retire, but 20% weren’t sure they’d stay in practice. I take such numbers with a grain of salt, though. That’s partly because, as I said above, doctors like to complain. That’s also because saying what you are going to do in the future is not the same as what you will actually do. In case people hadn’t noticed, the job market isn’t too awesome out there. I think many physicians are delusional if they think they can just quit practicing medicine and find another lucrative job.
But I think that the reasons that primary care docs say they might quit are illuminating. Those reasons are likely the things that make them unhappy about practicing, and we can definitely learn from that.
Continue reading “Why Are Primary Docs Thinking About Leaving Medicine?”
Filed Under: Physicians, THCB
Tagged: Affordable Care Act, Physician Shortage, primary care
Mar 22, 2012
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.
Continue reading “America Needs Different Doctors. Not More Doctors.”
Filed Under: THCB, The Insider's Guide To Health Care
Tagged: OECD, Physician Shortage, primary care, specialist physicians
Nov 11, 2011
Thanks to the passage of lawsuit reforms, medical care is now more readily available in many Texas communities. For many patients, this change has been life-altering; for some, life-saving.
George Rodriguez walks today thanks to tort reform. Newly established Corpus Christi neurosurgeon Matthew Alexander urgently operated on Rodriguez’ spinal abscess, relieving the pressure on his spinal cord, and sparing him life in a wheel chair. Without the state’s lawsuit reforms, Dr. Alexander wouldn’t have relocated to Texas and Mr. Rodriguez would have been deprived access to emergency neurosurgery in Corpus Christi.
Cancer survivor Ruby Collins credits newly minted Brownwood urologist Daniel Alstatt with saving her life. Dr. Alstatt says he wouldn’t have moved there, were it not for tort reform.
Andrya Burciaga of McAllen, a complex patient with diabetes and hypertension, is a first-time mother, thanks in part to the expertise of obstetrician/fertility specialist Dr. Javier Cardenas. Again, if not for the passage of the reforms, Dr. Cardenas says he absolutely would not have returned to his hometown to practice medicine nor taken problem pregnancies such as Ms. Burciaga’s.
Because of reforms, more patients across Texas are getting the care they need, when they need it.
Eight years ago, Texas was in the throes of an epidemic of lawsuit abuse. High numbers of meritless lawsuits, combined with excessive awards, caused doctors’ medical liability rates to double within just four years. Non-profit nursing homes saw their rates jump 900% within that same time frame, while hospitals saw liability costs increase as much as 50% in one year. Roughly one in four doctors was sued every year while the vast majority of these suits and claims were closed without payment.
Continue reading “Better Care in Texas Thanks to Tort Reform”
Filed Under: OP-ED, Physicians, THCB
Tagged: medical lawsuit, Physician Shortage, Texas Alliance For Patient Access, Texas health care law
Oct 26, 2011
Pop quiz. How many doctors are at the top of Mt. Everest? None, actually. Yet, think about how many people get sick up there. Think about how many die? Do you think extra bonus payments could coax a few doctors to relocate up there? What if we waived their student loan debt? If you find these questions interesting, there’s clearly something wrong with you. But cheer up. As the map below shows, there is a lot of variation in the number of people per doctors across Texas counties. [Thanks to Jason Roberson and his colleagues at The Dallas Morning News for making the data available.] At one extreme, Bandera County in the Texas Hill Country has 21,266 people and only one doctor. At the other extreme, Baylor County, near the Oklahoma border, has 666 patients per doctor.
Should we care about any of this? If so, why?
Before getting into specifics, let me address a cultural issue that I believe greatly prejudices all discussions of doctor location.
Bandera County bills itself as “The Cowboy Capital of the World.” It clearly promotes tourism. But the online reviews of its eight area restaurants don’t make me want to visit any time soon. Ditto for the online reviews of its 10 hotels, motels and dude ranches. Still, a lot of people visit there and it has a growing population.
Continue reading “Where Doctors Locate”
Filed Under: Physicians, Superhealthanomics
Tagged: Geography, Physician Shortage
Feb 8, 2011
The best electronic health record on the planet isn’t going to help anybody unless a physician uses it. The HITECH incentive scheme should enhance the woefully poor EHR uptake rates among US providers, as should innovative vendor business models that remove cost-barriers which have prevented many from getting in the game.
But there’s an even more fundamental issue, which is a looming manpower shortage among the ranks of US primary care physicians, a topic we’ve covered numerous times, most recently here. There simply aren’t enough physicians to use those EHRs!
Communities across the nation have long suffered from a lack of PCPs. The problem is expected to worsen as baby boomers age and the number of medical students who enter primary care continues to drop. If nothing is done to change current trends, the Association of American Medical Colleges estimates our country will be short 21,000 and PCPs in 2015 and a whopping 47,000 in 2025.
Now, finally, something is being done. And while it may not be enough, it certainly points us in the right direction. More importantly, it sets a precedent for future interventions by the federal government.
This Wednesday, Department of Health and Human Services Secretary Kathleen Sebelius announced $250 million worth of new investments designed to support the training and development of more than 16,000 new primary care providers over the next five years. The investments were mandated by the Affordable Care Act, that controversial health care bill signed into law by President Obama in March.
Continue reading “The Primary Care Workforce: Help is on the Way”
Filed Under: Physicians
Tagged: Glen Laffel, HHS, Physician Shortage, primary care, Sebelius
Jun 18, 2010