The Coming Doctor Shortage
The doctor shortage was fostered in 1996 when Congress capped the number of new doctors Medicare would pay to train, a practice that continues to this day. Teaching hospitals, which now make up about 10% of hospitals nationwide, depend on those Medicare funds to pay about two-thirds of the cost of doctor-training.
Health care reform will add an estimated 32 million people to the ranks of the insured, driving them to seek medical attention that in the past they may have avoided due to expense. The aging population will also create much greater demand.
According to a 2010 report by the Association of American Medical Colleges, the increased demand means that our nation will need an additional 130,000 doctors, both general-practice physicians and specialists, 15 years from now. That’s about 20% more doctors than we have currently.
Full article on the coming doctor shortage.
Mark Perry at Carpe Diem asks some good questions about this. Maybe you could answer them.
http://mjperry.blogspot.com/2011/01/theres-coming-doctor-shortage-but-why.html
Interesting post.
So medical school tuition doesn’t pay for doctor training?
Some of foreign medical graduates attend medical schools in the Caribbean and then complete their third year doing clinical work in New York State hospitals prior graduating and beginning residency. Some of the medical colleges based in New York are mad that the Caribbean medical schools are actually paying the hospitals to make the training slots available to students from Caribbean-based schools.
Now the traditional medical schools based in New York are trying to force these schools to provide clinical training in the Caribbean (which they cannot possibly do). Despite the shortage of primary care physicians, the industry still tried to erect barriers to entry.
Professor Perry has nailed it. I’m afraid that Dr. Pardes’ article is a classic example of a certain genre: The physician-advocate who want his “cake and eat it too.”
I’m sure that the shortage of physicians is more due to the increasing control of third-party payers, and the relative decline in physicians’ incomes to those in other professions, than it is to the federal government’s capping subsidies to medical schools.
An economist would surely conclude that an uncapped subsidy would lead to a surplus of physicians, as well as a decline in quality of medical education.
Furthermore, it’s a little rich for a profession that believes it will profit from the state increasing subsidies for medical demand to also demand more subsidies for medical supply! Let’s go back to one of my oft-use metaphors – the housing market.
Suppose the federal government decided that the government should increase subsidies for housing. And not the way it does now, by a mortgage-interest tax deduction and a cap-gains tax exemption, but by an actual government program to buy houses for people.
“Long-termist” architects would advocate against the proposal, because they would realize that it would lead the government to decide what type of houses they should design; their skills wopuld become stunted; and their energies devoured in lobbying the Department of Housing and Urban Development for a higher fee-schedule.
Unfortunately, as the government moved ahead, these architects would become dominated by “short-termist” architects who would see the increased demand as a boon to their incomes. (For those who don’t “get it”, this is obviously a metaphor for the devolution of the American Medical Association from the period before the Kerr-Mills bill in 1960 to the passage of Medicare & Medicaid in 1965.)
Imagine if the short-termist architects, after passage of the bill guaranteeing them incomes paid by the government, then lobbied the government to pay for their education, citing a “looming shortage” of architects. That would take a lot of nerve, IMHO!
Since we have a doctor shortage now, the question raised here is what are we going to do as a Nation to get through the rapidly looming crisis; beginning in 2014 when millions more people have insurance cards but no doctors to treat them regardless of what the doctors are paid?
We might need 130,000 more Docs in 15 years, but we’ll need 120,000 more by 2020; and since it takes 10 years to “make a Doc”, unless we have that additional number starting now, we’ll be very short by 1214, let alone 2020 or 2015!
Most know that a doctor’s career starts around 30 years of age, so as a demographic group most have “made the grade” after 35 years, having paid for their education, their homes and vacation homes in many cases, and put their kids through College, etc., just as most other people have. And demographically there are more “baby boomers doctors” than any other demographic group, so if 130,000 of them retire or “cut back” their practices over the same time period, having 130,000 “new” doctors in 15 years will only allow us to “break even” on doctor numbers, already one of the lowest patient to doctor relationship in the World. Rather than talking about “death panels” will we begin talking about “life panels” for there will have to be a mechanism to establish who will get services. So we will see either a system that gives fewer services to all, or a sector [probably the poor and under educated] that gets little or no services, and will probably be very mad.
Some say that nurses will fill the gap, but they are in short supply as well and economic theory says that shortages increase costs not decrease them. We could always shorten the time lines and graduate doctors into general practitioners in 5 years and allow them and nurses to provide most of the care as a sort of screening element. But these people want more from life and are committed to 40 hour work weeks.
Since most of the people needing most of the services will be seniors, going from seeing specialists to seeing general practitioners won’t probably be seen as acceptable either.
Can costs will be forced down artificially? And even if they can be it doesn’t increase supply.
Think again, Mr. President and Congress, for this formula won’t work!