Closer Look: Doctor Shortage
Some say there are already symptoms. Long waits in the ER, longer waits for a simple doctor's appointment. It's part of what some are calling a shortage of new doctors. June 21st, 2006 @ 8:53am
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The way to go is to be a PA (physician's assistant). You get all the cool medical work and none of the responsibility. You make a very nice salary and after the Dr. who you work under pays all the malpractice insurance, you're making just about as much as he is. =))
The American Medical Association limits the number of doctors that can be trained in the US in order to maintain their monopoly pricing power. There are many qualified applicants that are turned away.
@J. L. - Try going to nursing school. 3000 applicants 32 slots. Dr.s aren't the only short supply.
@Sadiesue A. - But this article is about doctors.
@James N. - That was about as useful as a comment as mine was. Pray I am not your nurse next time you are sick.
@Sadiesue A. - It is extremely expensive to train nurses and physicians. It can cost upwards of $300-500k to train an MD. In spite of the average medical student paying for some of that and finishing with over $100k debt (and some up to $200k), the rest of that must be picked up by the schools. Much of this is paid for by government, either directly or indirectly through taxes. When the legislature can't even find $2 million to fund dental medicaid, asking them to fund millions to train more MDs isn't going to happen. Ditto nursing school.
It is also very hard to predict the number of MDs needed. A few years ago, there was going to be a glut. Now there is going to be a shortage. It takes close to a decade (pre-med, 4 years med school, 3-6 years residency) for training, so if predictions and policies change every few years, there is a very long lag time until the number of doctors is changed. You may increase the number of slots now, but 10 years from now when those folks finish their training, they may be predicting an oversupply again.
Finally, medicine is unlike many other areas where increased supply = lower costs. Studies have shown that the number of many procedures per capita in a given area is directly related to the number of MDs in that area. So if there are more MDs, all trying to keep busy, the per capita rate of procedures goes up. As a nearby example, Utah county has one of the largest rates of spine surgery in the country, up to 5 x other areas of the country. This isn't because they have more back problems, but because there are more spine surgeons there.
Cheers.
It is also very hard to predict the number of MDs needed. A few years ago, there was going to be a glut. Now there is going to be a shortage. It takes close to a decade (pre-med, 4 years med school, 3-6 years residency) for training, so if predictions and policies change every few years, there is a very long lag time until the number of doctors is changed. You may increase the number of slots now, but 10 years from now when those folks finish their training, they may be predicting an oversupply again.
Finally, medicine is unlike many other areas where increased supply = lower costs. Studies have shown that the number of many procedures per capita in a given area is directly related to the number of MDs in that area. So if there are more MDs, all trying to keep busy, the per capita rate of procedures goes up. As a nearby example, Utah county has one of the largest rates of spine surgery in the country, up to 5 x other areas of the country. This isn't because they have more back problems, but because there are more spine surgeons there.
Cheers.
@Mike S. - "It is also very hard to predict the number of MDs needed."
That is why the AMA should stick to medicine and let market forces determine how many doctors there will be. The market is much smarter about economics than is the AMA. Self-interested individuals deciding whether to pursue a career in medicine are best equipped to determine whether it is worth the risk that there will be a glut. If there is a glut, the are smart people and can take a different path if the economics lead them there...
That is why the AMA should stick to medicine and let market forces determine how many doctors there will be. The market is much smarter about economics than is the AMA. Self-interested individuals deciding whether to pursue a career in medicine are best equipped to determine whether it is worth the risk that there will be a glut. If there is a glut, the are smart people and can take a different path if the economics lead them there...
@J. L. - The AMA has no say what-so-ever about the number of medical school spots. Most medical schools are state operated. Any medical school can have as many slots as they wish; the limiting factor is the amount of money available. Come to think of it, the AMA has no direct control of any facet of medical education or medical practice. TMO a retired MD
Joanna, I would like to shed some light on your comment. First of all PA's and NP's (nurse practitioners) have a huge responsibility, it is called their patients life. Secondly, there still is a bit of a salary gap. In Utah, PA's and NP's start out around $50,000/yr. Thirdly, I do agree, PA's and NP's are a great way to go. They really do help a lot of people. Utah still does not utilize them as much as other states, but that is starting to change. It will also help the doctor shortage. Thanks for your comments.
@Aaron H. - Oh relax.. i wasn't saying they didn't have medical responsibilities of saving lives.. i mean they don't have the responsibilities of malpractice insurance...if they mess something up they're going to feel bad..but they're not going to get sued..the Dr. that's over them gets that honor.
One additional comment. IHC, now called Selecthealth, limits the number of providers in each area that they will allow on their insurance to maintain their monopoly. Our clinic tried to get IHC to let us see patients with their (IHC/Selecthealth) insurance, but they rejected us stating they allready had a sufficient amount of their own providers in the area. Does not seem fair?
@Aaron H. - All insurance companies do this (limiting the number of physicians on a given panel) - and it actually helps keep DOWN the cost of care. All NON-IHC plans also limit the number of providers/hospitals on their panels (ie. Altius, Cigna, etc.) because they can then negotiate a discount. IHC does have a panel where you can see just about anyone you want (IHC Care), but it is also the most expensive plan, so very few people sign up for it.
If a physician knows that he/she is part of a smaller select group of providers, they are willing to accept less for a given procedure, making up for it in increased volume as patients are "forced" to see them. If the physician was on a panel that accepted anyone, they wouldn't be willing to accept the "reduced rate", and therefore the insurance would be more expensive.
As long as access is not an issue, and there are enough providers on a panel in a given area to meet need, there is little reason from the panel's point-of-view to add more providers, as that would just drive up the cost of the insurance. So from a provider's point-of-view, it might not seem fair if they are not on the panel, but from a person trying to pay for expensive health insurance at as low of a rate as possible, it does seem fair.
It's a difficult problem with no good answer. As long as everyone wants "everything possible" done for them, whether they are insured or not, and will sue for bad outcomes whether or not it was actually anyone's fault, the system will never be fixed.
Cheers.
If a physician knows that he/she is part of a smaller select group of providers, they are willing to accept less for a given procedure, making up for it in increased volume as patients are "forced" to see them. If the physician was on a panel that accepted anyone, they wouldn't be willing to accept the "reduced rate", and therefore the insurance would be more expensive.
As long as access is not an issue, and there are enough providers on a panel in a given area to meet need, there is little reason from the panel's point-of-view to add more providers, as that would just drive up the cost of the insurance. So from a provider's point-of-view, it might not seem fair if they are not on the panel, but from a person trying to pay for expensive health insurance at as low of a rate as possible, it does seem fair.
It's a difficult problem with no good answer. As long as everyone wants "everything possible" done for them, whether they are insured or not, and will sue for bad outcomes whether or not it was actually anyone's fault, the system will never be fixed.
Cheers.
I agree, PA's can help in the decreased Doctor population. My complaint with them is, If you're going to be given a doctor's bill, I want to be seen by a doctor. If you are going to be seen by a PA, then I want PA's bill, which better be a lot less that the doctors. When I make an appointment for me or my family, I try very hard to make sure the appointment is with the doctor and not a PA. Not that I don't think they are not competent, but there should be a finiacial break for the consumer who isn't being seeing my a medical doctor. I wouldn't pay the price of a Cadillac for a Honda.
Another thing: If I could, I'd see a pharmicist about actual medication long before I saw a doctor about them.
Another thing: If I could, I'd see a pharmicist about actual medication long before I saw a doctor about them.
Two items:
1) three day work weeks. 2 hour lunches. Not bad working conditions. (Granted, some work more hours than that.)
2) You are charged just as much to see a PA as you are a doc. And IHC limiting the doctors that you can see is just wrong. What ever happened to consumerism? Maybe the price would go down if you could see the doc that you wanted to see.
1) three day work weeks. 2 hour lunches. Not bad working conditions. (Granted, some work more hours than that.)
2) You are charged just as much to see a PA as you are a doc. And IHC limiting the doctors that you can see is just wrong. What ever happened to consumerism? Maybe the price would go down if you could see the doc that you wanted to see.
@Sleight M. - Since when? All of my doctors over the years, and the one I had worked for, all work 4-5 days a week, 8-10 hour days.
Some take a 1 hour lunch (like many businesses) but the one I had worked for didn't take a lunch break. We all fit lunch between patients.
Some take a 1 hour lunch (like many businesses) but the one I had worked for didn't take a lunch break. We all fit lunch between patients.
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12:29pm - Wed Jun 21st, 2006
Cons: Insurance companies who won't pay unless everything is submitted exactly right (and who change their rules quarterly), individuals who are under or uninsured who can't pay but still demand the same care that people who pay for insurance and their receive, long hours PLUS being on call regardless of the length of shift you have just worked, paying up to half of your salary for malpractice insurance for when (not if) you get sued... the list goes on...
Maybe I am just shortsighted, but I don't see where the payoff for being a doc is anymore.
2:10pm - Wed Jun 21st, 2006