The doctor shortage (hat tip to @FutureDocs and @efalchuk)

5 Nov
2009

The Coming Shortage of Doctors

Nice try article in the Wall Street Journal.  We already have a doctor shortage, and it is worsening.

The writer tried hard, but missed the point.  He did not explain the issues in a complete enough fashion.  The comments unfortunately also miss the point.

We must always separate 2 issues – the number of medical students graduating in the US and the number of residency slots.  The US fills most of its residency slots each year.  Since we do not have enough US graduates, we take many international medical graduates into residency.  Most of those graduates do practice in the US.

The AAMC did control the number of medical school slots based upon flawed assumptions about the number of physicians needed in the US.  The errors they made are laughable in retrospect.

  1. They assumed that women would work as many hours as men did.  Men in 2009 are generally not willing to work as many hours as men did in 1979.
  2. They assumed that medical care was static.  Technology advances have created demand and need.
  3. They did not understand that our successes would lead to longer life spans, and thus more need for care (older patients require more medical care!)

So we are increasing medical school slots, but residency slots are not increasing.  So we will have a higher percentage of US born physicians, but we will not have more physicians.  The only way to get more physicians is to increase residency slots.  Since most hospitals depend on CMS moneys for residency slots, we are stuck.

Some commenters worry about taking too many physicians from India.  Those commenters do not understand how many excellent physicians India produces each year.  In no way do we cause a "brain drain" from India.

No matter what we do, we must reform the primary care job to make it more desirable.  Our payment system has transformed a excellent job (with somewhat lower pay) into a mediocre job (with significantly lower pay).  Unless we redefine the job, we will not get many graduates to aspire to the job.  If you are reading this blog for the first time, please search on primary care for many rants on this subject.

So we have a doctor shortage; we will have a worse doctor shortage; and worse yet, our doctor shortage will be worst in the most important sector of medicine – primary care.

Related posts:

  1. Will primary care residency slots make a difference
  2. It’s the job – the only solution to primary care
  3. Catch-22 – what the NY Times op-ed missed
  4. Health care reform should address student debt
  5. ACP on having enough adult physicians

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3 Responses to The doctor shortage (hat tip to @FutureDocs and @efalchuk)

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Matt S.

November 6th, 2009 at 11:11 am

I also like how the author implied I was foolish for entering primary care.

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Dr. Bob (FP)

November 6th, 2009 at 3:13 pm

The assumptions about women may be a little more nuanced.  They tend to be less productive in their childbearing years (age 25-34), but compared to men, a higher proportion continue working into their older years (age 55-64).  See "Comparison of Physician Workforce Estimates and Supply Projections", JAMA, Oct. 21, 2009. 302(15): pg. 1677.

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Dr. Butler

November 19th, 2009 at 7:34 am

  Without due process in peer-review, medicine is unsafe for doctor and patient in the Land of the Free; one sentence could amend HCQIA of 1986:  "Due process is now a Condition of Medicare reimbursement."
  A prudent student will consider this situation when deciding whether to study medicine, and when choosing a country in which to practice.

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