Doctor Shortages
Things have gotten so bad in the health care paradise of Canada that a Manitoba radio commentary says Canada should "Solve Canada's Doctor Shortage by Copying European Health Care."
Specifically, it says that Germany, France, and Portugal have 50 percent more doctors relative to their population than does Canada. The Canadian Medical Association estimates that between 4 and 5 million Canadians do not have a family physician. Without a family physician Canadians can access health care only through walk-in clinics or emergency rooms. Some researchers suggest that the Canadian shortages are exacerbated by government payment schemes. Because the government pays a fixed amount for each office visit, primary care physicians maximize their income by providing less comprehensive services and structuring their practices to concentrate on patients with simple problems that require shorter visits.Too bad the Canadian commentators don't read the German press. A recent commentary by Deutsche Welle, Germany's international broadcaster, notes that the doctor shortage that has "long plagued the health care system in eastern Germany is becoming more pronounced in the western part of the country."
In Switzerland, swissinfo.ch reports that the current darling of some US health policy wonks faces a serious shortfall of doctors by 2030, in a country where secret treatment rationing is already a problem.
Copying Europe might make Canada better off, but Canadians should note that some European countries are looking to the U.S. for reforms that create systems that allocate health resources more efficiently by being more responsive to price signals. As Elizabeth Howell pointed out in the February 12, 2008 edition of CMAJ, the Canadian Medical Association journal, the "definitional and demographic difficulties" involved in estimating both the number of working physicians, their specialties, and the numbers of them likely to be needed in the future, makes planning difficult [link].
All the more reason, economists would point out, to free health care from government control and let the price system work to eliminate shortages.
It’s sort of ironic that Canadians are complaining about doctor shortages given the fact that limiting access to doctors and high tech equipment is one of the ways they ration care. The average wait time between requesting a specialist appointment and actually receiving treatment is about 18 weeks. Also, their government imposes an intentional policy of limiting doctors to reduce “unnecessary” care. This is done by limiting the residency slots and medical school capacity.
What Is Reasonable And Necessary
In recent times, others have appeared to express understandable concern about the apparent shortage of primary care doctors (PCPs) in the United States- a shortage that exists both presently, as well as in the years to come due to a number of variables.
Less than 20 percent of medical school graduates go for primary care as a specialty as a residency program today, it has been reported.
Typically, the main reason believed for this shortage is lack of pay compared with other medical specialties. Some anticipate a shortage of 60 thousand or so PCPs in the future within the United States. Many of the PCP doctors who practice right now would not recommend their specialty, or even their profession, it has been reported.
I believe the tremendous value as PCPs has not been acknowledged to others as it should, nor do I believe their income where it should be for what they do.
It is estimated that the U.S. needs presently tens of thousands more primary care physicians to fully satisfy the necessities of those members of the U.S. health care need, who are the citizens, now and in the future.
Ironically, PCPs have been determined to be and likely are the backbone of the U.S. Health care system- they are specialists of everything medically. Yet if this is true, it is not reflected in many ways compared with their peers of other medical specialties.
For example, PCPs manage the many chronically ill patients who benefit the most from the much needed coordination and continuity of care that PCPs historically have strived to provide for them.
Nearly half of the U.S. population has at least one chronic illness- with many of those having more than just one of these types of these illnesses. A good portion of these very ill patients have numerous illnesses which are chronic. The chronically ill are responsible for well over 50 percent of the entire Medicare budget, who are largely cared and treated by PCPs.
The shortage of primary care physicians is possibly due to other variables as well- such as administrative hassles that are quite vexing for the physician vocation overall.
In addition, the PCP continues to experience increasing patient loads that is complicated by the progressively increasing cost to provide care for their patients due to decreasing reimbursements from various organizations the doctors receive for the services they provide.
For reasons such as this, it is believed that some PCPs are retiring early, or simply seeking an alternative career path. Those in medical school now seem to be aware of the demoralization of this profession.
As mentioned earlier, the PCP specialty is not desirable choice for a late stage medical student, so this is quite concerning to the public health in the United States. The number of medical school graduates entering family practice residencies has decreased by about half over the past decade or so. PCPs also have extensive student loans from their training to complicate their rather excessive workloads as caregivers with decreased pay, so I can understand if they are a bit demoralized.
Despite the shortage of these doctors, primary care physicians do in fact care for the populations they serve and are dedicated to their welfare and restoration of their health- as difficult as it may be for them at times.
Studies have shown that mortality rates would decrease due to increased patient outcomes if there were more PCPs to serve those in need of treatment.
This specialty would also optimize preventative care more for their patients if allowed to do so. Studies have also shown that, if enough PCPs are practicing in a given geographical area, hospital admissions are decreased, as well as visits to emergency rooms. This is due to the needed continuity in health care these PCPs provide if numbered correctly to serve a given population of citizens.
In addition, PCP care has proven to improve the quality of care given to patients, as well as the outcomes for these patients as a result are more favorable. Most importantly, the overall quality of life for their patients is much improved if there are enough PCPs to handle the overwhelming load of responsibility they presently have due to this shortage of their specialty that is suppose to increase mildly if at all in the years to come.
The American College of Physicians believes that a patient- centered national health care workforce policy is needed to address these issues that would ideally be of most benefit for the public health. Policymakers should take this into serious consideration.
“In nothing do men more nearly approach the Gods then in giving health to men.” — Cicero
Dan Abshear (ex-military medic and physician assistant for nearly 20 years)
Author’s note: What has been written has been based upon information and belief of a layperson, yet also the assessments of a patient.