Doctor In The House?

An article in today’s newspaper herald a looming shortage of doctors… just as the Affordable Care Act is about to make health care more available to millions of Americans, there will be too few doctors.  What are they trying to say?

The quoted experts said the shortage is already baked into reality.  It takes about 10 years to produce a doctor, these sources said, and so ACA or not, there will be a shortage.  What are we to do?

Some will blame the Affordable Care Act for putting demand upon the system when the system cannot respond.  Others will say this is a problem of spot shortages.  That is, in big cities or populated suburbs, no problem.  In rural areas or economically depressed regions, not so good an outlook.

So should the call go out for “full steam ahead”, train more doctors and fast?

It might be instructive to also remember that US health care costs (per capita) are almost twice that of Germany and France (and about 15 other modern countries).  Outcomes arguably are not even as good.  Why then should US doctors in aggregate, be making so much money?  And, how can the US afford to increase the number of doctors even further?

The answer of course lies in fixing an inefficient health care delivery system.  At present the US pays for service and not for outcomes.  Why not run 10 diagnostic tests and be more sure of your diagnosis?  Why not discharge a patient and readmit a few days later when both events are paid for?

Some are calling for repealing ACA and hint that this will reduce the pressure on health care delivery.  They may be correct since health care, other than emergency room access, will be out of reach for millions.  How can these advocates sleep at night?

Doctors, especially those highly skilled, deserve to be well compensated.  The question is how much is enough?

Our society is not much help with the widening gap between the wealthy (job creators) and everyone else.  Doctors are as smart (or smarter) than most CEOs and senior executives.  Specialists are very well paid.  In comparison, however, general practitioners make a comfortable living but do not make as much money unless they abandon general practice and specialize.  This adds more years of study and training and reduces the number of preventive care physicians.

In a free market, customer driven, society, how can there be a shortage of well paid doctors?  Repealing Affordable Health Care can not be the answer.

I have confidence, however, that the medical profession could fix both the availability and cost issues it if politicians stayed out of the discussion.

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4 Comments on “Doctor In The House?”

  1. Terrant Says:

    “In a free market, customer driven, society, how can there be a shortage of well paid doctors? Repealing Affordable Health Care can not be the answer.”

    One reason for such a shortage is that there are some very steep barriers to entry. For instance, to qualify, one has to have top test scores, take on huge debt, and, of course, residency with long hours and very little pay. That is the result of the AMA so the the supply of doctors is limited to maximize profits.


  2. I think by placing a greater emphasis on outcomes, this could create a system where more doctors found it profitable to become primary care physicians.

    My thinking goes that if you make it more important that patients are healthy to begin with, that it deemphasizes some of the need for more and more specialists.

    I could be wrong, but it seems like the move to results based medicine might have this as a byproduct.


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