Brian Klepper was recently up at Medscape bemoaning the lack of physician leadership in righting the troubled ship of our health care system, and challenging physicians to do better.

He got lots of feedback, not all of it as negative as you’d think, and he had his own response. All well worth reading.

On the other hand, HSC says that in real terms we’re paying physicians substantially less than in 1995. I suspect that most of that pay "cut" was in the 1990s, and things seem to be picking up again, but — as one reader asked me — there is not that much good data on physician incomes, and in real terms they did very well between 1960 and 1990.

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.

So why did I get so grumpy with the secretary of the AMA and his talk at TEPR. I actually stood up and asked a long question which he interrupted to tell a bunch of lies about Canada, ignoring that there are lots of other countries with universal health care that do it differently and better. When I finally got to ask about why when ePrescribing was originally mandated for Part B in the house version of the 2003 MMA eRx legislation and ask as to why it mysteriously was left out of the final bill, and what was the AMA’s role in that — well as Neil Versel said to me afterwards “no one dodges the question like the AMA.”

Things he featured prominently………………The uninsurance crisis and how tough that is for doctorsThings he didn’t mention……………………The AMA’s long, long history of opposing universal health insurance including 1994

Things he featured prominently………………The AMA’s proposal for tax credits for the uninsuredThings he didn’t mention……………………That those proposals do almost nothing to reduce uninsurance

Things he featured prominently……………….How Pay for Performance was unfair on doctorsThings he didn’t mention……………………The AMA’s long, long history of opposing quality improvement

Things he featured prominently……………….How Medicare pay rates have fallen by half over timeThings he didn’t mention……………………The vast real increase in physician incomes since 1965

Things he featured prominently……………….How physicians will drop Medicare patients if fees go downThings he didn’t mention……………………The research that shows that this is untrue and an empty threat

Things he featured prominently……………….How other countries government’s paid for doctors’ ITThings he didn’t mention……………………How other countries doctors earn much less than him and his colleagues

Things he featured prominently……………….How the government should pay for physician IT but not mandate its useThings he didn’t mention……………………Every other business has been force to get IT to better serve its customers

Things he featured prominently……………….How Canada has rationing and is going to allow some private medicineThings he didn’t mention……………………That low–middle income Canadians don’t go bankrupt from the cost of health care

Yup, apparently it is just everyone else’s fault and physicians have no need to change anything.

I am on record as wanting doctors to run our health care system. I want physician organizations to get the money and decide its rational allocation . But apparently organized medicine’s response is to bury its head in the sand and demand that the rest of us hand them a blank check, and let’s all pretend it’s 1972 again.

Please please someone tell me that this guy is an anachronism and that he really doesn’t represent physician opinion….or else I will get even more depressed…