Obama, Heal Thyself
An April 26 article in the New York Times reported:
The need for more doctors comes up at almost every congressional hearing and White House forum on health care. “We’re not producing enough primary-care physicians,”Obama said at one forum. “The costs of medical education are so high that people feel that they’ve got to specialize.”
This quote demonstrates precisely the stilted logic based on flimsy assumptions that characterizes the intellect of our statist new presidential administration. That primary care physicians are in short supply is not in dispute, but the shortage certainly doesn’t stem from the cost of medical education, according to a November 2008 consumeraffairs.com report:
“At a time when the new administration and new Congress are talking about ways to expand access to health care, the harsh reality is that there might not be enough doctors to handle the increased number of people who might want to see them if they get health insurance,” said Walker Ray, MD, Vice President of The Physicians’ Foundation. “It’s as if we’re talking about expanding access to higher education without having enough professors to handle the influx of students. It’s basic supply and demand.”
“Basic supply and demand”? What a concept! No wonder the lumpen redistributionists populating the regulator-in-chief’s administration are unable to puzzle out this problem. The study of free markets and capitalism has apparently been excised from the Ivy League diploma-mills attended by our new pontificating elite. When faced with a thorny issue needing redress, the community organizers in charge first ask: How can we regulate this problem into a benefit for our pals?
A primary discouragement to the pursuit of medical degrees is, in fact, the onerous amount of regulation already foisted on medical practitioners. The same consumeraffairs.com report noted:
The reported reasons for the widespread frustration among physicians include increased time dealing with non-clinical paperwork, difficulty receiving reimbursement and burdensome government regulations.
Combine the discouraging expansion of bureaucratic paper shuffling requirements with the punitive cost of malpractice insurance and you have the regulatory perfecta, reducing the number of men and women willing to undergo the rigorous demands of preparing for the medical profession. An April 2003 article in the New England Journal of Medicine stated:
The medical liability system as we know it is highly flawed. It poorly compensates those injured, drives up the cost of health care by forcing physicians to practice defensive medicine for fear of being sued, and is driving good doctors out of practice.
Mmm…how to cut hospital lines? I know: Close the Mexican border first. Second: Keep a close eye on those pasty white Canadians.
Healthcare, one of my favorite topics. Primary care has a couple of things working against it and yet access to primary care can help patients manage many chronic conditions like diabetes and asthma in a cost-effective and beneficial way.
Medical education is expensive and by the time they finish medical school and residency, it is not uncommon for MDs to be facing educational debts over $100,000. So they are less likely to go into a specialty that pays a relatively modest wage and into one where they may have been told, “You are too smart to do primary care.”
There is a tremendous need for more access to primary care in rural areas and many states have taken advantage of federal $ for community health centers. Nurse practitioners and physician assistants can play a vital role in meeting the MD shortage and the distribution problem.
Over time, the government payers have shifted dollars to reimburse medical-based specialties more and procedure-based specialties less. This will continue and although it’s unpopular with many, it seems like the right way to go.
Just my political view–BHO does not seem to understand economics very well so I hope he will leave healthcare supply and demand to those who do. The AMA, CMS, AAMC, and schools of nursing can make important contributions to designing a better system. Insurance companies need to be responsive to the changes and not drive them–again just my view–because their incentives are so clearly in the areas of denying or delaying payment.
The best thing we can do is for all sides to stop the “administrative arms race” and have a more straightforward way to verify eligiblity, benefits, and billing requirements and do this electronically.
The people who now answer your computer support questions will be your next primary caregivers. They’ll have the same qualifications they have now. Obama will import them by the thousands to provide care and you won’t have a choice. That’s how the shortage will be addressed. Single payer it is.
Obama and Democrats will have their own physicians, of course.
The problem is beyond simple numbers: certain specialties have not been replacing themselves due to restrictions on the training programs. For example, General Surgeons are becoming scarce and the existing group are aging with huge percentage over age 55. Lead time to train replacements is almost 10 years if you had the programs and the faculty to do so…which we don’t. Many other key specialties are in much the same situation.
As the system becomes less capitalistic it is taking half again or twice as many doctors to do the same task as none want to work the same hours as those of us did in the past. It is even worse when federal and state governments demand us to care for their “insured” under Medicare or Medicaid at less than our cost of providing the service…not a business plan where we will make it up on volume.
When I finish in the next year, there is no replacement in sight for at least two years. Nationally, we are graduating at the most 8 candidates per year and the current need is >30, most for academic positions where one has residents doing first call in departments of a least two or three others. What young person in there right mind is going somewhere where they have no backup, daily call and virtually no chance of getting a partner?
Then even if we increase the number of graduates with an MD, Zerocare will reward primary care at the expense of specialty care. This will compound the problem…just as it has with this scenario in Canada. Who is going to work twice as hard for the same or less money?
It’s refreshing to read a piece written by someone who really gets it. I am a family physician who graduated from medical school in 1979 and finished my residency in 1982. At the time, medical education was indeed a bargain. I had a total debt of $11,000 and the interest was forgiven until I finished residency. Then it was something like 3%. After a few years in practice I simply wrote a check for the balance.
Family medicine was on the make in 1980. The U of Minnesota Medical School, where I trained, encouraged careers in primary care and really cranked out graduates who selected family practice. At one time there were seven residency programs in the Twin Cities alone and I think there were about 40 doctors produced each year. Now those numbers are greatly reduced and the programs, in spite of being downsized, are having trouble filling.
Yes, medical tuition debts are higher, but that doesn’t tell the full story. What has depressed me and my colleagues is the utter contempt with which our specialty is treated and the increasing hurdles of paperwork and non-reimbursed care we are providing. Most physicians I know value autonomy more than anything. As more and more of a pseudo-business model is adopted in health care( cookie cutter care guidelines, exaggerations about medical errors, over-reliance on technology and electronic medical recors) we become more and more estranged from the patients, the people we used to work for. Now we work for the government and private health care insurance companies. I don’t distinguish between the two. Specialists are seen as having more autonomy, not just money, by medical students. If we wanted to make money, there are ways to do that that require less time and effort. What I forsee is the dilution of the talent pool by poorly educated health care extenders who will use committee-designed protocols to treat patients and “save” money while expanding the numbers of people eligible for health care benefits. The health of the American public will not improve except in carefully designed studies in which the outcome is pre-ordained by the bias of the planners. We will start to see health care access rationing in a more overt sense. Now it is covert. Remember the death of Natasha Richardson? That was caused by the inadequate medical infrastructure of Quebec. No rapid CT scan, no air ambulance, though she was wealthy enough to have paid for it. If an illegal immigrant crack addict is turned away from a hospital in Texas, the ACLU is all over it. I think the priorities of the so-called progressives are obvious to anyone with one eye open. The baby boom generation is about to be handed the biggest slap in the face by the architects of the re-designed health care system in the US.
Philip Markoff is an extreme case, but substandard ethics abound in medicine. My own extended family had a doctor who was sent to prison for Medicare fraud — and then his practice (headed by his knowing mother) was permitted to continue by the AMA. I, myself, have had several mediocre doctors and misdiagnoses based on borderline incompetence. But one thing is certain: they ALL had high GPAs when they were admitted to med school. Medicine (and the number of doctors) will benefit enormously when the ADMISSION CRITERIA are re-structured so that overall intelligence, academic competence AND evidence of ethical and moral high standards are equally valued. We will then have MORE applicants—applicants who had well-rounded, normal lives in college rather than driven, grade-cruncher existences. And I dare say they will be BETTER doctors, too.
I tried doing primary care in a small town- until my accountant told me I would only make $35,000 one year. I now work ER only for much higher pay. Obama can wave his arms and make all the promises he wants, but nothing will change until the economics change.
By the way- it takes a MINIMUM of 11 years to train a doctor ( neurosurgeons can take at least 15 years). I’ve told my kids that if they ever express an interest in medical school, I’ll beat them until they change their minds.
I am a doctor. My practice is hospital based and has been under attack by medicare through cuts in reimbursement for the last 15 years. The transfer of medicare patients to private insurers resulted in a large drop in reimbursement to physicians. Our incomes have already dropped by about 50% over that time period. As a hospital based specialist I see this administration’s policies as running me out of business. The costs of running a business, and the cost of malpractice insurance and claims against physicians have risen consistently over that time. Many if not most of the claims are frivolous (thanks to a lottery mentality and an excess of lawyers) or unrealistic. “Rule 1: Patients get sick. Rule 2: Patients die. Rule 3: Doctors can’t change rule number 2.”
I am sure I am not alone.
You will hear, as I have already heard, “that we have to change the system so it works for everyone” —–mind you, everyone does get treated. 30% of my patients have no insurance.
You will hear, ” there will be a lot of pain as we make these major changes but we have to go through it”. Tell it to those who die because of the damage that will be caused by these policies.
You will hear, “We will make mistakes as we institute these changes, but we will keep working at it until we get it right”. The truth is you can very very seldom go back once you have made these changes. Particularly when they come as entitlements.
I grieve over the death of Healthcare. I am looking for alternate careers. I’m 48 years old and have been in practice for only 16 years, but I am considering retiring or moving to another country, though I’m not sure which one. I was originally thinking of looking for one with an unfettered healthcare system with the intention of working there, but have since changed my mind. Now, I’m just looking for one that is somewhat safe and still has a healthcare system that will be able to treat me or my family if I need it.
I graduated from medical school in 1977 and my total debt — undergraduate and med school — was about $14k. That was a fair amount of money in 1977.
But that’s not the issue. My daughter is working on an MS in medical illustration *at* a medical school, and and given her Phi Beta Kappa and MCAT scores would have been a prime candidate at most med schools in the country. Since dad is paying her tuition and living expenses, she’ll graduate debt free. It’s not the finances that stopped her from applying to med school, it’s the hassles associated with medical practice today. It’s just not worth it to many.
I agree with drjohn above. Expect an influx of physicians from India, China and Mexico.
Mind you my hope is that healthcare reform fails. My hope is not for myself, as I believe I can thrive in most areas. My hope is a wish for healthcare and Americans. Especially those who do not believe that it is the responsibility of the nanny state government to provide every need.
The problem with health care is spending on it becomes a bottomless pit. Medical science need to understand that illness, infirmity and death cannot be abolished. At the moment peoples’ hopes are being raised too far
BTP typical of your stupid comments -
The socialized system coming to the U.S. via the present administration will not “fail.” Did anyone see the press conferences put on by the former Illinois Governor, Rod Blagojevich before his outster? He presented former patients who received free care through medical programs he initiated in Illinois. The availability of quality care will plummet but the survivors will be more than happy to give their tearful thanks to BHO and his bureaucrats, loudly proclaiming that they are alive only because of the government programs. Those who die (or worse) will be forgotten; no one will know that they would have survived with a decent system of private care. Both parties are to blame: name one federal program that has been eliminated or significantly reduced after it got a decent foothold. Obama-care is on its way to a hospital and clinic near you and me. We can complain but most of the members of the so-called opposition party will be on board. While nominally criticizing the plan for being too big and too expensive, their real complaints will not be based on a belief that government medical care – like government banks and government car companies – is simply wrong. Our government doesn’t do a good enough job on its basic mission of protecting us from criminals and foreign threats to branch out into finance, manufacturing and healthcare.
Actually, its “The Shadow” who is off course, and “BPT (Australia)” is right on course. I live in the southwest and every day on the news, there are articles about illegal aliens winding up in very nice trauma centers, and guess who pays the bills, every day Americans, that’s who. Finally people are starting to wake up (hopefully its not too late) about the extravagant costs that illegals foist upon our medical system. Between lawyers who force doctors to second guess everything and order expensive tests, etc, and our laws which make emergency services open to anyone and you don’t have to show anything, the cost of treating illegals is no longer insignificant.
School officials are starting to look at the hugh expense of handling non-english speaking students who come from families that don’t pay taxes, but do receive all types of free benefits.
Securing our border will not stop everything and certainly not lower costs of everything, but its a good start and if handled properly would definitely benefit our financial bottom line.
It’s not terribly difficult to cut medical costs. Here are 6 steps to do this.
http://hyphenatedamericans.blogspot.com/
Reagan talked about MSAs and catastrophic insurance during the 1980 campaign, but once elected, nothing changed. 28 years later, nothing changed. This issue was handed on a silver platter to the Demos by the Repubs. One party is to blame for sleeping at the political wheel, and the other for exploiting any and all crises (opportunities) handed to them.
The quickest way to improve the low numbers of doctors graduating from this nation’s medical schools will be to severely curtail medical malpractice suits. Not only do med students have to face years of paying off debts just to learn to be doctors, but they then have to carry hyper-expensive malpractice insurance. And for what? So a bunch of shysters, whose only real claim to fame is not getting run over by the ambulance they are chasing, have a raison d’etre. And then we elect another lawyer president. And not only a lawyer, but a statist lawyer.
11. Ian Thorpe quoth thus:
The problem with health care is spending on it becomes a bottomless pit. Medical science need to understand that illness, infirmity and death cannot be abolished. At the moment peoples’ hopes are being raised too far
Totally agree with you Ian. Been there and still doing that. How many mammograms and biopsies or partial mastectomies in the pursuit of what? Did we really reduce the mortality from breast cancer? (I can give the boring references but who wants to hear that while surfing the ‘net?)
Great old line. Got to actually use it a few times.
Patient: “Well, am I going to die”?
Doctor “yes…eventually. I am sure of that. Not from this though”.
Aside from that expect no less from the medics than constant pushing to the limits of what you can bear, financially or otherwise. After all that is our job and vocation. I think we all want that.
Spindok
Show Obama, Reid and Pelosi the tea party protests were not “astroTurf” but they were the beginning of a massive movement against massive Government growth and the control that comes with it. Tell them to Empower Individual Americans to take responsibility for their own lives and for the individual to have control over the direction of our country Sign the petition for Individual Empowerment!!! http://www.PetitionOnline.com/Indv1776/petition.html THE ONLY WAY THIS WILL WORK IS IF YOU COPY AND SEND IT TO FRIENDS AND FAMILY THAT HAVE THE SAME OPINIONS AS YOU. ALSO COPY AND POST IT ON OTHER NEWS SITES, BLOGS, EMAIL IT TO ORGANIZATIONS ETC
I am a primary care physician and the owner of my own practice. I am concerned about the future of medical care in the US because under Obama’s delusional and misguided plan, it will be foreign medical graduates filling most of the primary care job positions. I have seen first hand the lack of knowledge many of these physicians have, even after finishing residency in the US. They also lack cultural sensitivity. Also concerning is the possibility of widespread use of nurse practitioners and physician assistants. I no longer hire any of these physician extenders because I have had such horrible experiences with their poor judgement and poor knowledge base. The quality of healthcare will significantly decrease.