Comments on: One of the unintended consequences

By: greg

greg — Wed, 31 Dec 2003 10:42:06 +0000

Having practiced Solo Internal Medicine for 25 years I feel the COMMODIFICATION
of Medical services will be the future.
Safe and efficient use of TECHNOLOGY requires NUANCE. I am humbled every day
in Medicine. The ART of Medicine will simply be beyond those that see only BLACK and WHITE. The enterprising forces in Medicine have CRUSHED the Nobler attempts
of Doctor Patient relations.

By: CHenry

CHenry — Wed, 31 Dec 2003 02:34:18 +0000

Well, to the first, and anonymous, poster, I certainly hope that the AMA would oppose a strategy of flooding the U.S. with foreign-trained doctors. And I hope the collective establishment of universities with medical faculties and anyone else concerned with the survival of an American system of medical education would also oppose such a reckless and shortsighted idea. It might seem convenient to fob off the costs of educating the future doctors of America on the good citizens of India, Argentina, Russia, Poland, South Africa and other countries (and they do produce good graduates, I have no argument with you there) but it would come at a price of undermining our own university training institutions while at the same time robbing those countries of their valuable human capital.

By: CHenry

CHenry — Tue, 30 Dec 2003 20:46:26 +0000

Since when might staggering personal debt not be an impediment to entry into any kind of business, professional or otherwise, let alone one where costs rise faster than reimbursements? And since when is the idea of pushback to intrusion into personal time such a novelty, especially when the marginal return for that time might be small, and the cost great to one’s family and oneself?

By: Robert Prather

Robert Prather — Tue, 30 Dec 2003 15:03:11 +0000

db,

What Greg said and what you said as well. The fact that physicians can control their hours suggests that there is a shortage — they have great pricing power and control of their work environment, as well as hours.

I have a friend who was a nurse anesthetist and she simply told the hospital that she wanted to work four days a week and they had little choice but to meet her demands. Physicians are probably similarly situated.

This does bring up another issue: moving work from more expensive doctors to highly qualified technicians and nurses. It seems to me that there’s much to be gained there, though there’s a shortage of nurses right now as well.

By: greg

greg — Tue, 30 Dec 2003 11:00:10 +0000

A 24% increase in population is hardly
the issue. It happens to be the 300% increase in citizens entering their 7th
decade of life. This is where the AGGREGATE DEMAND on Health services begin.
The Boomers represent a Tsunami Wave of
Demand that will last 30 years at least
given technology. This phenom literally
changes everything political,economic and social America faces

By: BobL

BobL — Tue, 30 Dec 2003 00:05:50 +0000

I really feel this rant does not give the entire picture. This country is turning out 23,000 to 24,000 new MDs every year (that is because we have 15-16K US graduates and 7-8K foreign medical graduates entering medical residency programs in the US each year). The vast majority of foreign medical graduates remain in this country to practice medicine after residency by taking advantage of the different visa waiver programs. Usually these foreign medical graduates from countries such as Russia, France, India, etc. have little or no medical education debt and are thus in a better position to enter a US physician job market where salaries continue to erode severely, particularly when compared with increases in the cost of living. Why sentence more US grads to the US medical education debt nightmare, particularly when they may end up facing the nightmare of possible default on their loans due to the current physician job marketplace? If there is really a shortage, we might just increase the entry of FMG’s into residency programs from 7-8K per year to 11-12K per year or even higher. In Great Britain from what I understand, more than 50 percent of the MDs are foreign born and I see no reason why this will not occur in the US as well as we march toward socialized medicine.

By: Matthew Holt

Matthew Holt — Mon, 29 Dec 2003 22:37:39 +0000

Hmmm….
I’m very very curious as to when and why the phsyician supply crisis arrived so suddenly. Not 6 years ago in the BBA we started paying teaching hospitals to STOP training residents because we had too many. Furthermore the population may have gone up 24% in the last quarter century but the number of physicians has gone up closer to 100%, as before 1970 we only trained 8,000 a year, and has nearly doubled on a physician per capita basis.

Sure there are loads of things wrong with the incentives in the system but a shortage of doctors isn’t one of them. What we actually need are ways of better extending the doctors we have and a way of getting away from the “broken chassis” of lumping more and more onto the beleagured process of the office visit or inpatient encounter. That means using lower paid staff and technology to help patients rather than lumping it all onto the doctor visit. (see Don Berwick’s great article Escape Fire here)

And dare I say it, but the physician population has not been a good example of responsiveness to the laws of supply and demand. While their numbers have doubled over the last three decades so have their overall pay rates. But individual physicians have been very responsive to those pay rates–demand for sub-specialty residency places was double that for GP slots 15 years ago and (probably) still is.

By: Anonymous

Anonymous — Mon, 29 Dec 2003 22:23:00 +0000

How about if the AMA decided to allow easier access to immigrant doctors trained in other countries? That would vastly increase the supply ( as American doctors are much, much more highly paid than most other doctors). And some spiel about foreign doctors being inferior is nonsensical. But the AMA would oppose such measures tooth and nail.