Draining More Brains: Where Medicine is Heading
Watching the Affordable Care Act roll-out and reading about its gestation in Steven Brill’s book, America’s Poison Pill, makes one very aware that there is a serious brain drain under way in medicine. Here’s what anyone can see:
Numbers of applicants to medical school, which once was 10 for every place, is now less than 1. Physicians are telling their children not to go into medicine. There is now more than a 7 foot stack of regulations for the Affordable Care Act. As we all know, the slogan for this whole program has been “the healthcare system is broken.” (If that is so true, why force feed new people into it?)
Some manifestations: the adoption of the ICD-10 coding system, which defines conditions needing care in such detail that there is an unacknowledged administrative cost for compliance and a substantial legal and financial risk if there is mis-coding. Another is the forced adoption of Electronic Medical Records, with rules for “Meaningful Use.” This will produce electronic oversight of all medical care, in the guise of supporting “quality of care” and facilitating “Value-based Payments.” Ultimately, the government regulators expect to have real time access to any person’s care and any physician’s performance.
What this mentality does is assume that it is possible to oversee the healthcare system for 350 million people from Washington. There will be “untoward effects,” as physicians will rightly see themselves as a profession now in thrall to the government. Providers are docked a percentage of income they have already earned and receive only part of it back if their organization’s performance exceeds that of their peer category or their own prior performance.
The government will justify this by saying “We are only acting as a prudent buyer.” A physician is guilty until proven innocent, sentenced to punishment before a crime has been committed. Our best organizations–MD Anderson, The Cleveland Clinic, Virginia Mason, UCSF, and Stanford are regularly excluded from health plans’ networks.
The poor payment levels and the unilateral fee slashing for government entitlements are said to just be a buyer exercising a buyer’s rights to pay what they want to pay. What is not put forth is that the usual balance between buyer and seller–that if either does not like the deal, they can walk away does not reflect the reality–the government’s power is huge and the providers’ power is tiny. When the patient/customer is the buyer, there is a balanced interest in quality and price.
My Schadenfreude rejoices that docs are finally getting payback for all the conspiracies over the years to hide pricing and quality information from the public.
Unfortunately, new doctors are not the villains that the now-retired docs are.
It is true that the administrative burden being added for Medicare is costly and pointless. But the cited brain-drain evidence is completely incorrect – Medical school applications are at historic highs. The real effect of the stupid administrative cost is increases in operating costs for physician practices and, consequently, higher health care costs for patients.
The myriad of draconian regulations under which all providers perform are a simple stick with which the govt can come into any organization and clawback any Medicaid or Medicare money previously reimbursed to that healthcare business. It’s all about control. Private practices are becoming a thing of the past as it’s easier for the govt to negotiate with one large company employing hundreds of doctors versus negotiating with hundreds of self employed physicians. This is a long term move towards single payer – we are all frogs in a slowly simmering pot of one govt payer system and we don’t even realize it yet…until it’ll be too late.
Although the number of applicants per position may have decreased, the total enrollment in US medical schools has increased each year since at least 2005 according to the AAMCs data. It topped 85,000 in 2014. That being said, there is a large proportion of currently practicing physicians older than 55- especially in some of the surgical specialties. Given the long timeline for complete training, especially in specialties and the fact that the number of residency slots has not been significantly increased since something like 1987, I think we can expect some net decrease in absolute numbers as retirements outpace the number of trained physicians entering practice. One other bit of bad news is the increasing evidence that work hours restrictions have not resulted in improvement in the quality of resident training. On the contrary, there is a belief that senior residents are less well prepared for independent practice.
Where are you getting these numbers? Everything I can tell about medical school shows far more applicants than positions, even as more positions in medical schools open up.
http://blogs.wsj.com/health/2009/10/20/med-school-applications-flat-number-of-slots-grows-a-bit/
https://www.aamc.org/newsroom/newsreleases/358410/20131024.html
I’m also confused about the ICD-10 criticism, as it’s produced by the WHO, a European organization, and was created in 1992. This isn’t to saw the ACA doesn’t have issues, I just think what is focused on in this article is at best peripheral and at worst a distraction from what should be considered during this change in health care funding and delivery.