Physicians

PHYSICIANS/POLICY: Physician Shortage Looms–hold onto your wallet

Quoting a bunch of head hunters and a rural doc who can’t find anyone willing to move to Ukiah, the Los Angeles Times says this:

A looming doctor shortage threatens to create a national healthcare crisis by further limiting access to physicians, jeopardizing quality and accelerating cost increases.

And so apparently we must build more medical schools and train more doctors, even though the doubling of the number trained in the 1970s hasn’t fully worked its way through the system and won’t for another ten years.

Momentum for change is building. This month, the executive council of the Assn. of American Medical Colleges will consider calling for a 30% boost in enrollment, double the increase it called for last year.

Meanwhile the Dartmouth guys (who maintain their starring role in THCB) say something oh so slightly different:

AMC inputs were highly correlated with the number of physician FTEs per Medicare beneficiary in AMC regions. Given the apparent inefficiency of current physician practices, the supply pipeline is sufficient to meet future needs through 2020, with adoption of the workforce deployment patterns now seen among AMCs and regions dominated by large group practices.

The powers that be in health care are advocating more money to come directly from the taxpayer into the system to train more doctors, who will then cost the nation much more when they go into practice. Of course that’s a much easier answer for them than rational reorganization of the health care system by somehow or other making it all look more like Mayo.

So how do they start using language to persuade those of us suckers who are going to have to pony up for this that they’re right and the Dartmouth crew are wrong?

The AMA changed its position on the physician workforce a year ago, acknowledging that a shortage was indeed emerging. The consensus has shifted so quickly that experts who view the physician workforce as adequate — though poorly distributed, inefficient or wasteful — now are seen as contrarians.

So that’s it. Wennberg (and Goodman and Fischer and the rest of them) are now officially “contrarians”. Hmm…aren’t they the ones who make all the money on Wall Street?

CODA: The same edition of the LA Times has an article about the international outsourcing of radiology reading, which gives a clue as to how some of that “rational reorganization” might happen.

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Albert McCreaSHannon Brownleejack danielspgbMDBarry Carol Recent comment authors
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Albert McCrea
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Albert McCrea

I need help completing my medical training due financial constraints my med school offers no financial assistance I am a 3rd year med students from a carribean med school Windsor Unv.School of medicine I HAVE EXCELLENT CREDIT SCORES my school unwilling to give school code/info.to get loan please if anyone can help contact me at aljrmccrea@yahoo.com or 3015291204 desperately need assistance will explain in detail my situation I am in dire straits sincerely Albert McCrea

SHannon Brownlee
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The marvelous thing about the economics American health care is that it is a system of infinitely expanding demand. More doctors won’t mean lower incomes; it will mean more health care gets delivered! Hoorah for the market! I’m kidding, of course. When you dig deep into the Dartmouth Atlas data and especially into Elliott Fisher’s 2003 paper published in the Annals of Internal Medicine, it’s clear that one of the central problems we face is not a doctor shortage, but a patchy oversupply of specialists. The quality of care goes down, and mortality rates go up (!) in systems with… Read more »

Matthew Holt
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Matthew Holt

While it’s quite possible that I’ve said virtually anything about the AMA over time in this blog, I’ve never really subscribed to the “AMA restricts licensing to increase doctor incomes” school. Most data suggests that unless you control how doctors get paid, more doctors equals more care delivery equals higher health care costs and even higher “same store sales” doctor incomes. It’s manipulating how doctors get paid that has been teh AMA’s great success. The rationalization required would certainly change the ways doctors get paid…which is why I think the AMA is now saying, OK we’d rather you just made… Read more »

jack daniels
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jack daniels

FWIW, in terms of per capita doctor/patient ratio, the USA is in the top 3 in the world among OECD nations. Most industrialized nations have less doctors per capita than the US.
Doctor shortage, my ass

jack daniels
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jack daniels

This is a strange conversation, because I swore Holt argued awhile back that the AMA was involved in a massive conspiracy to keep an artificial shortage of doctors to jack up wages. Lo and behold, he changes his theory and now he believes that the AMA is involved in a money grubbing conspiracy to divert money from public tax funds. FWIW, I dont see any evidence of an overall doc shortage. Some specialties perhaps but not docs as a whole. All the “physician shortage” studies fail to account for 5 things which render their findings null and void: 1) They… Read more »

jack daniels
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jack daniels

Maybe our medical training system is too long, but there’s absolutely no evidence to indicate that it is subpar. If you are going to claim that its subpar, you’d better have some damn good evidence from other nations showing their doctors to be superior to ours. I see no evidence of this. I think US docs are roughly equivalent to european and asian counterparts. In most other nations, you go to med school straight out of high school. HOWEVER, med school in these nations is usually 6-7 years long, compared with 4 in the USA, meaning that you dont same… Read more »

pgbMD
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pgbMD

I agree that the first 2 years of the BS degree is exactly BS when compared to other countries. I took the O levels (7 As and 2 Bs for Matthew who has some idea as to how tough they are) when living in England in the mid 80s. Upon my return to the US, I could have skipped 11th and 12th grade in highschool and gone straight to college but opted to do 12th grade. Entering college at 15 years of age was a little too much for my parents. Even after skipping 11th grade I felt like I… Read more »

Barry Carol
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Barry Carol

I would be interested to hear what the experts think about how much time could be removed from the process of educating and training a doctor (post high school) if you had complete freedom to redesign the curriculum and the internship / residency / fellowship process, and what are the key changes and substitutions in the program that you would recommend?

Narayanachar Murali
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Narayanachar Murali

Agree with Theora. US medical education is outmoded. The requirement of a 4 year liberal arts degree before entering med school(for most students) is an absolute waste of time. Most other countries teach in high school what is taught in the first four semesters of a BS degeree in the USA. In essence, the first two years of the US college ed is remedial education. The consistent answer from the brightest students / high school high school seniors to “what do you want to study in the next 6 years?” is “I don’t know, I have not decided” . Students… Read more »

Matthew Holt
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Matthew Holt

Theora–you;re far too sensible to be involved in this discussion. Go sit in the corner with the other contrarians and be ignored!

theorajones
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theorajones

It’s also bizarre that anyone would suggest we send another person through our archaic medical training system. It’s a system that’s been largely unchanged since 1920, and so much of it is a waste–from 4 years of undergraduate school followed by 4 years of medical school followed by a ridiculously long itnernship, a ridiculous amount of which is spent in a state of total physical exhaustion, doing “scut work.” Not to mention the ridiculous amount of energy that’s spent in a mid-twentieth century curriculum, teaching students to memorize well and rely on the knowledge in their head–um, there’s these things… Read more »