Primary-Care Doctor Shortage May Undermine Health Care Reform Efforts

Washington Post:

As the debate on overhauling the nation's health-care system exploded into partisan squabbling this week, virtually everyone still agreed on one point: There are not enough primary-care doctors to meet current needs, and providing health insurance to 46 million more people would threaten to overwhelm the system.

Read the whole story: Washington Post

Comments

[CJWebber]

In Canada most doctors want to practice in a city (naturally), where the best technology and hospitals are. This creates a problem for the rural areas, where in some cases there is only one doctor, meaning they are always on call. In order to address this problem, and to make more doctors want to practice in rural areas, the government offers incentives to practice in some of these areas. Also, northern universities have built medical schools to produce doctors who, besides doing their residency in the north, will possibly end up living and working in the north.

There a lot of countries with great healthcare systems, I am sure the U.S. will adopt one. These endless excuses to prevent healthcare reform are ludicrous. It won't end up to be a perfect system, but it is bound to be better than the one you have now.

[Oldtimer]

WTF???
I don't know how many years I'e been saying that we need to use the VA
hopitals as medical training centers to bust up the AMA's monopoly on
medical schools. Cuba exports doctors for Crissakes and we allow
the AMA to keep M.D. numbers low here in the U.S.
Let's gobama. What the hell were you elected for??

[Lyr]

Malpractice insurance is absurd. My friends dad is an OB/GYN and he left this backwards sue happy country run by trial lawyers for New Zealand where you can't file insane lawsuits. He's much happier there and is head OB/GYN at one of thier major hospitals.

[apoyo]

Easy to solve.

Set up scholarship programs so that RN's can become Nurse Practitioners.
NP's can treat and prescribe to a certain extent.
They can refer certain patients on to the doctor.

Use available empty office space to set up screening clinics.
The mall would be a perfect place. There are many empty shops that have gone out of business.
An RN can run the screenings, do patient assessments, do patient teaching, compile medical histories and refer the patients on to the doctor as needed.

[AlsoSarah]

Exactly.

[Lyr]

Walmart uses Nurse Practioners to run affordable health clinics in some of thier stores. The AMA hates it ofcourse, cause poor people are getting health care cheap.

[takeyourballandgohome]

PAY THEM MORE!!! MORE $$$'s. You can offer the outpost practises (ask the doctor who went to Maine only to have his wife shot dead, and hunter acquited, for shooting and killing her in HER OWN BACKYARD, b/c she had white on her mittens, same as a deer's tail) but they deserve to have the respect of their colleagues.

Stop letting insurance companies reward them for the number of tests they order, and how to maximize a visit...le­t them look after patients, allow them more than the 15 mins. to diagnose, treat and nurture.

Chip a bit off the orthopaedi­st's....th­ey have enough for the mechanics they do, and give it to the guy who sends them the patients!!!

[Mugzi]

That is a pretty lame excuse for backing off of health care reform - I don't buy it! There are physician's assistants, interns, many in the medical community that could take up the slack. Heavens sake, send more of our young people to medical school! It's all about healthcare reform - not insurance. Healthcare reform should cover preventative care, diet, wellness, research and development of curing diseases, etc.

[beatbox32]

Good for you! Don't let those pesky facts get in the way of your ideology and force you to think of alternative ideas.

[JuliaRain]

What are your alternative ideas for improved health care?

[Sepulchre]

More than a little of the problem is the cost of medical school. I myself had given it some thought before I decided to pursue my PhD in a research science direction. Though honestly I am happier as a researcher, I won't say a large part of my decision way back then wasn't based on cost. If we want more doctors we have to make medical school more affordable.

[OneLiberalLady]

Yes, yes, yes!!! It would be so easy to help doctors in training out financially , perhaps on condition of some service to underserved areas for a period of time. What is wrong with us that we haven't done it before?

[AlsoSarah]

Actually it has been done.

[droftim]

It's done right now. the Indian Health Service has a program that will forgive a portion of a doctor's loans in exchange for 2-years of service. Of course the IHS has been so starved of funding in recent years that, as many as might want to apply, the service has no money to pay them.

There are other programs that pay for medical training in exchange for service. What we need to do is expand them in a rational manner.

[flapjack]

How about this? Medical schools stop charging so much for tuition. Many univesities have surplus budgets and yet they still raise tuition rates. Let's start by reducing tuition.

[Lyr]

You are leaving out the continuing cost of malpractice insurance. Medschool is cheap compared to the decades of malpractice premiums they have to pay.

[Sepulchre]

This is true, but I think the initial cost of the degree is what turns a lot of college students off going into medicine. They also need expand the number of slots open at medical schools, each year.

[AlsoSarah]

We have known this for a very long time. The answer to the physician shortage is not patient care refusal. We need to use our existing resources more effectively. We also need to make the healthcare profession more desirable to enter by excusing debt, providing educational grants, using more physician assistants, nurses and nursing assistants. Help needs to be extended to rural community and urban health care clinics. We should even consider using emergency rooms as an alternate community clinic using less equiptment and using physican assistants and nurses to screen chronic care. It's in place. Hire more healthcare professionals and paras. Train people and pay for it.

[Lyr]

Stopping absurd malpractice awards would help too.

[flapjack]

Why not reduce tuition rates?

[mydwyf]

Betty Ann Bowser (spelling ?) addressed this issue in an in-depth report on the PBS NewsHour last spring. Very few graduation med students are going into primary care. Something like 2 or 3 %.
Lots of women are matriculating and they are almost all going into specialties. They have been served
(nothing new here) a double whammy : Huge educational debt load (upwards of $500,000 when all is said and done) and a ticking biological clock. If they want to have children, by the time they are getting established in the medical field they are also getting into their thirties and have to factor their fertility in.
(Woe to anyone who gets pregnant before then, medical schools do not act charitably towards fecund students).

But they cannot start families with such a huge pre-existing debt burden. So they go into specialties in order to pay it down. This was all discussed very thoroughly in the report. Probably still available on the PBS NewsHour website.

Last week, my daughter told me that some of her classmates in medical school are literally selling their eggs in order to help meet their expenses.

[epiphany1234]

Selling their eggs to become doctors...­incurring half a million dollars debt.....t­his is outrageous in the "greatest country in the world."

This tells me that among some people there is a strong drive to become doctors, healers, which must go beyond the grandiose paycheck. I am sure thousands would be willing to become part of the public plan if the government paid for or subsidized their education and training, requiring only some years committment to the public plan in return, and a salary on par with other highly trained professionals.

[flapjack]

Why should the government pay for tuition? Why shouldn't the greedy schools lower tuition rates?

[conservativesscareme]

in Russia physicians don't make much money so most are women
In the USA profit driven smart people ( some without a heck of a lot of compassion) are attracted to medicine and especially to specialties with huge profits like plastic surgery.
No shortage in USA of plastic surgeons, are there?

[Lyr]

Yeah and no insurance covers plastic surgery. You can get a boob job for 2k, yet some people are reporting catscans can cost in the 3k range? what is going on? I think insurance is to blame.

[Giordano Bruno]

Actually this mismatch of needs compared to workforce (or low primary care to specialist ratio) is a direct result of the prevailing economic "free market" model in medicine. It is no wonder that far fewer are going into primary care when the hours are longer, the responsibilities greater, and the compensation lower. Generation X has shown itself (and I don't mean this to be judgmental) able to make pragmatic choices based on lifestyle and income considerations that my generation was unable to do, at least at the same rate. Consequently Pediatric and Internal Medicine Residencies are vastly underproducing adequate numbers of graduates.

I have long said, that free market capitalism doesn't work in the Health Care field. As Stanley would have said to Ollie, "...look what a fine mess you've gotten us into." The invisible hand has eliminated the services we need the most. Go figure. And the Republicans and Blue Dogs are afraid of reform. When they are ill, I wonder if those dermatologists and radiologists are going to be able to care for them in our places.

Giordy

[flapjack]

Well, you are wrong. Canada (not a free market) has a shortage of physicians as well.

[CJWebber]

There is only a shortage in rural areas. The urban areas don't have a shortage.

[CJWebber]

Canada's not a free market? Are you sure about that?

Canada has more regulations and controls than the U.S. (we aren't bailing out our banks), but it is still a free market.

[JuliaRain]

You are mistaken about our economy and how health care works in our country.

[tompoe]

Corporate media strikes again, attempting to legitimize an illegitimate argument. The manufactured doctor shortage is as absurd as the Twit Brigade's claim that single payer healthcare will destroy 1/6 of our economy.

[PaxEterna]

IN Europe, and other civilized places, students don't go into mountains of debt to receive the education they need to pursue a quality career and enjoy a reasonable quality of life.

In America, we make everyone go broke to get a few crumbs from the pie. everyon except the already well-heeled, and/or powerful.

With college kids graduating with upwards of 100k in debt for a 4 year education at a state university, how can we expect them, or doctors who sometimes incur hundred of thousands of dollars for their extensive training, to not become greedy and do everything for money.

The capitalist system has to be tempered with policies that promote the collective well-being of the citizens.

Like I said at the top, other civilized nations have figured this out.

We are woefully behind in our practices, not to mention thinking, vision, and strategic planning for the future.

[epiphany1234]

Thank you. It's time for a new paradigm of thinking in terms of education and training in the US.
Maybe doctors trained for the public system could be the catalyst, getting health care reform kick-started and off the ground, producing healthier & wealthier citizens hopefully.­......then on to other fields!

I get sick of people claiming we can't do this or that for one reason or another...­...while the rest of the world does it and marches forward, and we march backwards into the dark ages.

Yes we "CAN" is the name of the game.

[JuliaRain]

"I get sick of people claiming we can't do this or that for one reason or another"

I don't blame you! It is a cop out and is just an empty excuse against change and improvement.

[ObamAtomic]

Blame the Republican,their fault.

[flapjack]

Countries with socialised medicine have had shortages of doctors for years. Capitalism has nothing to do with a shortage of doctors.

[Lilith33]

The AMA maintains a shortage of doctors in this country.Th­ey care about profits not people.

Maybe we could ask Cuba to send us some doctors...­........th­ey have one for every block.Beca­use people only become doctors to get rich right?

[PlaceboStudman]

HuffPO does not seem to be lettting me respond to comments below, so I am posting this here. This is the Google Search for French Health Care. The reviews are mixed, but clearly the system is not the wonderful end all be all system that everyone seems to believe it is


http://search.aol.com/aol/search?s_it=searchbox.webhome&q=France%27s+health+care+system

[JuliaRain]

But it is still superior to the US system. Learn from them. Learn from their mistakes and successes.

[PlaceboStudman]

Over all it may be superior but some of the holes directly affect me and those I consider peers as the disabled. If the US can do what it takes to change our lifestyle to a more European lifestyle, then adopting the French system will be fine. But I wonder if people are going to be willing to do what it takes to break the addictions to McD's and Starbucks as well as changing our entire economy to prevent major congenital birth defects as I have. The french do this very well. Can we?