There are 830,000 doctors in the United States; almost half of them are over age fifty; and a significant proportion of them see fewer patients than they did even four years ago [Physicians Foundation Survey, 2012].
The problem of declining numbers of practicing physicians is compounded by several factors:
- physicians are less satisfied with their medical careers and are retiring early or going into other professions;
- baby boomers are swelling the ranks of patients needing Medicare;
- health care reform is ushering in millions of patients (as many as 30 million) who previously were uninsured but now have access to health care financially.
Family practice physicians are inundated already, and the massive influx of new patients has barely started.
The United States is, at this early stage of absorbing the massive numbers of newly insured patients and newly arriving Medicare recipients, short 16,000 family care physicians—family practioners, pediatricians, and general internists—and we are estimated to be short by 90,000 in the next ten years.
For a variety of reasons, all very important, we are not producing as many primary care physicians as previously and not nearly as many as we need now or that we will need in the future as the problem worsens: recent medical school graduates have accumulated massive educational debts; it is not at all unusual for the new M.D. to have $250,000 in loans which he or she will never be able to pay on a primary practioner’s income; so, he or she will face a lifetime career of paying the unforgivable (by law) interest debt.
That, of course, is a strong disincentive to practice primary care and a strong incentive to go into a higher paying specialty. Starting salaries for primary care physicians are from $80-120 or 150,000 per year compared to gastroenterologists and radiologists who make twice that and neurosurgeons, cardiac surgeons, plastic surgeons, and cardiologists who often bring in two or three times that amount per year.
There has been a major social change in attitudes of new physicians; they feel like they should have a life including time off with their families. They avoid specialties which require being up in the night, or of having onerous night, weekend, and holiday call schedule responsibilities.
Many bright and ambitious students are choosing other careers. State and private institutional funds are drying up; so, new medical schools are not being built or even planned. Current medical schools are decreasing the numbers of students in their classes. The massive costs in both money and time required to get through residency programs is daunting to many would-be doctors—five years for a neurosurgeon after an internship and core year of general surgery training, for example.
All of that begs the question of what can be done. The following list comes from several different sources, and it is well to bear in mind that We the People will have to bear some increased expenses in the form of taxes and increased insurance premium costs to make the changes happen.
- Some states are proposing that medical school be cut to three years instead of four.
- Some states offer incentives to family care doctors such as providing a scholarship to defray the costs of the first year of medical school.
- Many states and private medical care organizations offer a team approach—less complicated cases can be seen by nurse practitioners and physicians’ assistants. Some provide a sliding-fee scale for such care.
- Advances in technology, communication, and improved patient education can reduce the need for return clinic visits.
- “Physician extenders”—nurse practitioners and physicians’ assistants are being granted more autonomy to provide care, and the result is that more people are taking advantages of the incentives to become care providers without having to be caught in the web of confiscatory educational costs.
- Better health care education, especially with regards to diet, nutrition, exercise, and early preventative care, as provided by the Health Care Reform act serves to reduce the cost of medical care and the frequency of visits to clinics. The Health Care Reform Act of 2010 provides some funding for such purposes.
- Permitting more foreign trained physicians to become licensed in the United States is a measure that can bring an amelioration of the shortages quickly.
- The PPACA [The Patient Protection and Affordable Care Act—Health Care Reform—of 2010] failed in one major issue. Malpractice tort reform, such as has been enacted by the State of California, is missing in the Act, and that markedly interferes with all facets of the delivery of medical care, increases the costs, and reduces the number of physicians overall and particularly the number willing to take night call, to treat serious and complicated cases, and to treat people who are unable or unwilling to comply with good medical practice. That must change before the United States will be able to have a health care delivery system anywhere near comparable to the excellent systems in Europe.
- Better pay for primary care physicians is part of the PPACA, but it is too little and too late. Malpractice insurance rates are climbing at an alarming rate; Medicare payment rates decline or threaten to do so every year; and both of those factors discourage the best and the brightest from entering low paying fields. State and federal government sources must find means of increasing physician and auxiliary provider incomes or face an increase in the shortage of providers.
Finally, and of paramount importance, is that government must rid itself of the notion that healthcare is a fertile ground for political posturing. The doctor shortage is not a Democrat or Republican issue, a right or left issue, or an issue that can be ignored without serious consequences.
Health care delivery and improving our problem of an American shortage of doctors is just that: An American problem. It is time to get on with real, objective, and timely solutions and no more proposals made to ensure the re-election of anyone.
What do you think? Share you views, opinions, insights etc. by leaving a comment below.
Carl Douglass – Author
Carl Douglass Books
www.carldouglass.com
“Neurosurgeon Turned Author Writes With Gripping Realism”
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