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

[AlteSoldier]

A Consolidated System

They wanted a system that gave everybody equal access to health care — free choice of doctors, with no waiting time — and a system that encouraged a lot of competition among medical providers.

http://www.npr.org/templates/story/story.php?storyId=89651916

[FogBelter]

I believe the AMA restricts the number of Medical Colleges in the United States and because of that many fine candidates for the medical field are turned away due to lack of space.

There really is no shortage of doctors, we can handle the situation the same way we handle the nursing shortage with visas for foreign doctors who want to relocate here. That would be the short term solution, the long term solution would be the opening of more medical colleges, which would bring down the costs of Medical School as well (Especially if the US Government were to underwrite the costs for those seeking a career in the Medical field)

In short, there is always an answer for every problem.

[epiphany1234]

I agree wholeheartedly.....

If the government pays for or subsidizes medical education, then doctors would be obligated to work within the public system for a given number of years.....­whatever..­...5, 8, 10.....then if they wish they can move on to specialties or the private industry and earn the big bucks but still be obligiated to a given number of pro bono cases within the public system for the duration of their careers. In short, they will have to give back to the public system for financing or subsidizing their careers.

[JuliaRain]

This is a good idea and solution and should be part of new reforms.

[JuliaRain]

I have a question.

Does the AMA limit the number of new doctors to be trained?

Thank you in advance.

[JuliaRain]

This is troubling if it is true. Can anyone provide more information on this, please? Thank you.

"AMA's Limit and High Health Insurance

The AMA controls the number of doctors that can legally practice medicine in the U.S. The number limit of new doctors per year is set by the AMA. If there are more doctors than the limit number, who want to start practicing medicine, they cannot do so legally, even if they fill all requirements to be a doctor, such as the 8 years of medical school required."

http://www.bambooweb.com/articles/A/m/American_Medical_Association.html

Really?

[epiphany1234]

This needs to be stopped, if true.

[MED1025]

Nurse practitioners, physicians assistants and pharmacists could help to fill in the gaps by handling routine physicals, immunizations and the like. Medical school also has to become more affordable. No one should start out with > $100K debt.

[obamanomics]

Problem is once socialized medicine is firmly in place those bright young men and women won't be entering medical school due to the fact there will be more money to be made elsewhere.

[epiphany1234]

Fine....let them move to Wall St if money is what they ultimately seek -- as opposed to healing.

[NoblesseOblige]

For the most part, Democrats want and demand universal (single payer) healthcare for everyone. On the other hand, with only a limited and token "tweaking" of the current flawed and broken insurance company delivery system, Republicans want to vigorously maintain the status quo--and, oppose any sort of public option. For many of them, aside from their usual perception of feared and disdained government involvement, any meaningful change for all would preclude or seriously curtail their personal ability to see their own doctor on a timely basis.

That's why the Republicans are using fear words like "rationing"--which is simply code for "I've got my coverage and my doctor, and fVck everyone else". This selfish and detrimental mindset holds particularly true for the visible and vocal Republican members of Congress who already have lifetime comprehensive health benefits--courtesy of the tax payer.

In the end, we can only hope Congress gets this right. Quality and affordable healthcare for every American citizen is a right--not a privilege!

[rxvette]

This problem of a shortage of primary care doctors was created because our current healthcare system rewards reactive care and not proactive medical care. The doctors who get paid the most are the specialists who deal with patients once they're beyond the point of being helped by a primary care physician. For example cardiologists, endocrinologists, and surgeons just to name are over compensated in my opinion and it hurts the whole system. Do I think specialists deserve more than a primary care doctor? Yes! But do they deserve to make 5-10 times the amount of a primare care physician? No! That's what our healthcare system today does. Instead of putting incentives in place for the doctors on the front lines to keep people healthy it puts incentives out there to reimburse providers simply based on volume of care. The more patients you see and the quicker you get them in and out the more money is to be made. Our healthcare system is saying "Who cares if patients actually get well and stay healthy."

Think about it... would you rather go to 11 total years of school and residency programs to become a primary care doctor making an average of $150,000 a year or would you rather tack on 2-3 more years of specialty training and make $500,000 - $1million a year. It's not rocket science!

[Chas53]

I agree with most of your post, however you are wrong about endocrinologists. They make about the same as General Internists. The big ticket specialists are cardiologists, especially the stent jockeys; who's mantra is see blockage, place stent. I call them the "stentaholics". Read "The Great American Heart Hoax, by Michael Ozner MD for details. He refers to much of the stenting that takes place as "cosmetic surgery of the coronary arteries".

[drricklippin]

Here is one solution.

If I am correct there will be a surplus of highly paid currently overutilized specialists and subspecialists. These doctors could go back to primary care.

Sorry.But there are just going to be some economic losers in this health care reform.

But the big winners at long last will be the American health care consumers

Dr. Rick Lippin
Southampton,Pa
http://medicalcrises.blogspot.com

[PlaceboStudman]

In my experience, having been a "customer' of the health service for nearly 40 years now, I can say that you are spot on (I said something very similar to your point below)

[obamanomics]

Yeah, and the losers are going to be your patients Doctor. There simply will not be enough of you to go around, and the losers will be the ones having health care rationed out, namely the elderly. Look at the mortality rate for breast cancer in the UK. That should give you an indication of what is going to happen here.

[droftim]

Okay,,,let's look the popular breast cancer bugaboo. Do you have an actual citation for that so we can read the context?

Do you not believe the US has no rationing country today? If you don't think so, read the paper for a week and count all the stories about people who thought they were covered until their insurance company denied treatment recommended by their doctor. Listen to the sob stories on television about the people who were summarily dropped by their insurance companies when they got sick and started getting expensive.

The Institute of Medicine of the National Academies found that approximately 18,000 Americans die each year because they don't have insurance. How's that for rationing?

[mphalen]

I have a niece and a nephew who want to go to med school. They are both highly qualified and have the grades to attend but they don't have the money. They don't want to end up with $200,000+ of debt when they start out their careers. We would have plenty of doctors who are in it to save lives but the cost is way too high for many to pay. And doctors beholden to the insurance companies do not get rich.

[droftim]

Have they considered programs from the Public Health Service or VA where all or part of their student loans can be forgiven?

[Name Not In Use]

The problem is at the other end of medical school. Pay primary care doctors less than entry level police and fire with a high school education and force them to treat patients like a short order cook treats hamburger patties and no one wants that job.

[Name Not In Use]

http://www.opdjobs.com/oakland-police-department-salaries-and-benefits.htm

[CJWebber]

Anything as an excuse not to reform healthcare.

[IssuesInFocus]

Absolutely! To those who are not looking when you stop by your local hospital/c­linic/doct­or's offices Primary Care Physicians have been hard to find for a very long time in this country. FMGs (foreign medical graduates) from India and elsewhere have been filling the gap.
So whats new? Time to get more of our students to study medicine. In the interim, Primary Care doctor shortage as a means to undermine reform of a decaying infrastructure is unacceptable! http://www.youtube.com/watch?v=vN5PbSvFFAE

[ps89]

If there is a shortage, then it is with the private insurance industry. It should not be a deterant- an excuse - to not provide publicly-funded care. This excuse of a shortage of doctors is just more propaganda against public option reform. We see it for what it is.

And I agree with mphalen.... make education affordable - I think... even FREE! That will be next on our great American progressive agenda. Just wait and see. Free healthcare, free education.... publicly funded for the good of the great and the pursuit of happiness.

[epiphany1234]

If they see a shortage of PC's, why not set up a public medical school open to all levels of society with the idea of producing PC's specifically for the public system? On the national level, not open to local peculiarities and money shortfalls and the rest. Let the American people cover the cost to produce first rate MD's for their public system.

Anything is possible. We need new paradigms for a new age and a new way of thinking.

[Name Not In Use]

The problem is at the other end of medical school. Pay primary care doctors less than than entry level police and fire with a high school education and force them to treat patients like a short order cook treats hamburger patties and no one wants that job.

[epiphany1234]

What you describe is nowhere in my concept.

I am talking first rate medical practition­ers....tha­t have to meet strict academic standards of grades, excellence, and achievement. The national med school could be connected with a hospital to provide internship, everything funded by US tax dollars, and treat patients enrolled in the public plan. If we can fund myrad wars and pay for $600 toilet seats and fill the pockets of Halliburton and Blackwater, surely we can train doctors in this country on the taxpayer's dime. The idea is to make medical education and training available to the hordes of potential doctors among the American people who would love to practice but can't now afford to become doctors. And I am talking available to ALL -- all the bright minds going to waste in inner cities and jails and dead-end jobs. The idea is to produce qualified doctors to work within the public system.

[mphalen]

We could take a lessen from Cuba.

[poster1122]

The flaw in that strategy is that med schools accept pretty much the top 1/3 of MCAT test takers already (those scoring at least 1 standard deviation above the average). Getting students loans isn't a problem once you've been accepted to a decent med school (or an even mediocre one).

Your proposal to open it up to everyone is problematic because it effectively means lowering the standard to accept students who couldn't make it into the top 1/3. I think a lot of people would be rather nervous about that.

But even if you could solve that problem (or don't think that's a problem), there's another issue: Primary Care physicians don't make very much, relative to specialists. So the bulk of medical students take up a specialty. So either you close the pay gap between a neurosurgeon and a general practictioner, or you force people out of specialty.

I'm having a lot of trouble believing either option will fly. The first essentially takes away a reward for acquiring expertise. The second requires someone say we have too many oncologists, obgyns, neurosurgeons, heart specialists, etc, etc.

[epiphany1234]

Actually, I'm elimating "loans" and "don't make much" out of the equation. Maybe that has been the source of many of our failings up to now. I also think the malpractice fears doctors face has to be eliminated somehow, but that we also have to deal with
malpractice realistically.

I think with the public system nobody would promise doctors a grandiose paycheck.
Maybe a livable paycheck similar to other highly trained professionals would be acceptable....I think many people might go into the profession not for the buck but to be able to heal people -- and may find this attractive. The system somehow could be set up with rigorous standards that would admit only the best and the brightest.

I believe taking the profit out of health care would be a good thing for our country.

[droftim]

The last thing we need in this country is another professional school or a system of "public" vs "private" doctors. We already have mechanisms such as loan foregiveness or service in existing public facilities that can be used to encourage physicians to go into primary care.

[iridium53]

Primary Care Physicians - aka insurance-fronting gatekeepers to receiving good care - are also being squeezed by insurance companies and the system.

They do not receive all that much pay, their malpractice insurance and education loans leave them with less spendable cash than most good mechanics.

All this while insurance company executives, that Congress and Obama are working so hard to protect - take a third of the money out of the system to produce nothing. Their primary job is to deny coverage.

Part of any healthcare reformation must include some way to address these issues.

[droftim]

that is exactly why PCPs ought to support Single-Payer reform rather than line up with the specialists who designed the payment system in the first place.

I don't see why we can't have some form of loan forgiveness to Doctors who practice in shortage categories. We do it for teachers, why not for doctors.

Why couldn't we say that a doctor in general practice would have his payments waived for 4 years then forgiven at 10% for each year after? That would give them incentives to work in Primary Care, or an underserved area long enough to make it worthwhile to the public.

[lastams]

WOW!
While the Senate has been busy trying to kill public healthcare, telling us all that it’s not “politically possible”, along comes this proposal from the House Democrats putting an honest to God sensible public healthcare policy squarely on the table.

http://blogs.abcnews.com/thenote/2009/06/house-dems-unveil-health-care-plan.html

With 2 out of three Americans now favoring some form of government supported healthcare, it will be interesting to watch our bought and sold Senate trying to
put the genie back in the bottle.
Congrads to House Democrats for finally finding some intestinal fortitude.

Note to Huff:
A mention of the proposal might have been nice, I mean it's only the number one issue on the minds of Americans these days.

[Mugzi]

You're right...WOW!!! This is the answer for everyone...

[ps89]

Those house dems are heroes who will not give up. Thank you Waxman, Rangel, Miller!!!!
Write them. Let them keep the fight going.

[houseafire]

Any excuse will do to bat down and undermine the Health Care Reform....should they bring in a porcelain or a metal kitchen sink next?

[PlaceboStudman]

How did I know that a perfectly good article about a real MEDICINE issue would be twisted and contorted to another blanking issue about insurance? Can't ANYONE think outside the box and try to plan ahead to what will happen once everyone GETS insurance>?? Who cares who pays and how much you're paying if there aren't enough doctors to go to in the first place? That has NO connection with insurance. That problem will only be solved by a shifting of the American psyche away from specialized medicine and back to a system of general holistic medicine that considers the whole body and the interactions of one system on another. We need to reform the education system to teach med students how to treat the whole patient, including their mental health. People often forget or neglect the incredible impact that mental health has on physical health. Frankly I thought that was a no brainer once I learned that one of the symptoms of chronic depression was physical pain. But, hey, that's just me. Makes me wonder if I'm smarter than everyone else sometimes cause I seem to be the only one figured that one out

[Eres]

If ONLY Americans could think outside of the box and beyond the bottom line. Institutions providing public services like education, health care services and insurance coverage need to be reigned in and held responsible for creating this mess. No one should have to pay $200,000 for an education, period. No one should go without health care, period.
We already know that our education system has been hijacked by predatory lending institutions and the government turns a blind eye. There has been no effort by this administration to address the student loan industry that drives young people into deep unmanageable debt before they ever graduate with 4-year degree which is a huge factor in our failing economic system.
Groups like Student Loan Justice are working hard to shine the spotlight on this problem but it seems our congressional leaders (Dems and Rethugs) have no interest in addressing the problem. Until we can provide decent affordable education in this country, we have little hope of maintaining our competitiveness as a society.
Combine that problem with the insurance industry mafia, who take our hard earned dollars and refuse to pay for services and this is what you get.
It would be great if the media would give this issue the attention it merits but unfortunately we don't have a responsible or legitimate public media either. So, it seems we're destined to spiral into a third world country occupied by a stupid and sick population.

[PlaceboStudman]

It would also help if we could get away from the Higher Education Corporation, where state schools cut funding for all departments within a School while simultaneously raising their university president's salary. We need to have a Universal Education system where our taxes go toward paying the salaries of well educated teachers and reimburse them for the quality of their work, not the quantity. Higher Education should be FREE...period. Health insurance too. But, just as doctors neglect to treat the whole patient and only seem to work in super specialized areas of interest, the government seems to not be able to see how education impacts Health Care, the economy, etc. Everything is seen as their own department and the interaction between departments is dismal at best

[fifty8]

A well educated and critical thinking populace would not be so easily led and
therefore a threat to any government.