Discussion in 'Political Discussion' started by Patradomous, Aug 15, 2012.
John C. Goodman: Why the Doctor Can't See You - WSJ.com
Well, here's the choice:
Don't expand healthcare because doctors are limited.
Expand healthcare and force the system to train more doctors.
Not having the foresight to train enough doctors is not a valid reason to deny healthcare to the uninsured. You can't order medical schools to take more people. You can, however, give them a bigger market and give them the incentives to expand and create more schools.
These are inevitable growing pains.
Actually, by necessity, there will be a third lower level, the mid-level provider for those not in the typical or concierge practice.
Man In Trouble:
The man says to the nurse, "Help me please"
Nurse "What seems to be the trouble"
Man "I can't breath, my chest hurts"
Nurse "Have a seat in room four please"
The next day, 10:00 AM, New Communist Barack Hospital:
A man in a wheelchair with one arm, no legs and a little sign attached around his neck that says "I am blind, I have Parkinsons Disease" comes down the hallway and stops in front of the nurses desk, he removes a breathing tube from his mouth and says, "Good morning nurse"
The nurse replies, "Good morning Doctor Shakesbad"
Dr Shakesbad asks, "do you have anything for me this "wheeze" morning"
Nurse "yes doctor, there is a gentleman in room four with chest pains"
Doctor "well, go in and tell him I'll see him next Tuesday"
Nurse "yes Doctor"
The nurse steps into room four, there is a dead man on the floor, human feces and urine are all over the walls, the nurse yells at the dead body and says, "DR SHAKESBAD WILL SEE YOU NEXT TUESDAY"
LOL yeah so let's reduce physician compensation, add confusing outcome and population health metrics, increase their liability costs and let their student loan debt pile up.
Brilliant! And you wonder why medical students have been trending towards specialty practice...
The Affordable Health Care Act addresses many of these concerns:
There's quite a bit more detail in the link - if you're interested.
Fact Sheet: Creating Jobs and Increasing the Number of Primary Care Providers
Well dear have you tried bartering a chicken or two to see the doctor?
My Dr is an Indian (from india) I like him but I don't know what the f-ck he's talking about.
Yeah it's incentivizing NPs... not PHYSICIANS.
Value based purchasing is all about eliminating hospitals as centers for cost and shifting them to lower cost community providers. There's also restrictions on physician-owned hospitals -- I believe Obamacare blew most of those up.
And oh by the way Obamacare's budgeting includes cutting physician pay by 22% but refusing to continue the "doc fix". Add that on top of penalties for meaningful use and everything I said before is 100% true. You can set up training centers but who will actually be incentivized to become a physician?
Doc - Question on the bolded above. How do you force the system to train more doctors?
I could be reading it incorrectly, or missing your point completely, but how do force someone to train to be a doctor?
In your hypothetical above, our choices are don't expand because the one resource is finite (doctors), or expand by forcing more people to train to be doctors?
I have always viewed being a doctor (or a lawyer for that matter) as a choice someone makes to (in some order) help society and make a very nice income. If doctor incomes decrease from more government involvement in payouts (ala Medicare vs private insurance payouts) why/how would you increase the number of doctors?
Seems to me that if the financial gain from the 22+ years of school (all grades through med school and residency) is lowered, less people would choose to sacrifice their time to become one (opportunity cost).
Again - I could be completely missing your point. Looking forward to your clarification/thoughts.
"...Within the decade after that, an additional 30 million people are expected to acquire health plansâ€”..."
well, that's clearly unacceptable. How dare they inconvenience those of us who already have health insurance or the money to pay for healthcare ourselves?
(You know, there are valid criticisms of Obama's health bill -- but highlighting a passage that speaks of more people actually getting healthcare doesn't really make a good argument.)
ACA increases Primary Care compensation. Regardless:
Taking care of doctors while also getting people healthcare aren't mutually exclusive. There is no other way around increasing the number of doctors without increasing demand for them.
And increasing residency spots (which are paid for by the government).
The limiting factor for the number of doctors in this country is the number of medical schools. The limiting factor for the number of medical schools is the number of residency spots.
Residencies are positions at hospitals where medical graduates do their post-graduate on-the-job training and learn the stuff that can't be learned in the classroom. They have nurses and other doctors show them the ropes while they gradually take more and more responsibility for care under the oversight of another doctor.
However, you have to pay for the attending physician who keeps an eye on these guys, you have to pay for the Resident, who on average is 26-32 years old and has 200k of debt and at this point needs a salary, as well as the ancillary costs involved. The contribution the resident gives versus his costs make him a poor choice of employee to be honest. Hospitals don't really want resident - it hurts their bottom line versus just hiring a fully trained doctor.
The government foots part of the bill here, on the idea that help paying for residents is a public service that would not occur in the private sector. Unfortunately, decreased and or stable levels of funding have ensured that the number of residency spots has not kept in pace with the number of doctors needed.
Medical schools won't open more spots/New ones won't be created until there are places for their students to go! A doctor can graduate and get an MD, but he cannot practice until he completes a residency.
The idea is that once the healthcare pool expands, the alarm bells of not having enough doctors will be enough to finally get legislators to boost residency funding to where they need to be. We are already short of doctors, hopefully such a drastic lack of doctors will make legislators realize residency funding is not something that should be easily cut.
There are other things too: Some people claim that the American Medical Association artificially limits doctors through their control of medical schools to keep their salaries high, but I think that's bull****. There are already way too few doctors and their salaries don't necessarily increase with more patients. Artificially limiting them makes no sense, especially with the knowledge that we need so much more of them.
On the other hand, some people also say that hospitals take advantage of residencies by making them wage slaves. They intimidate them into working over the 80 hour a week limits and squeeze them for hours while also collecting subsidy checks from the government. Residencies lasts 4-8 years, and this practice has an effect of pushing people toward specialties since if you're going to get whipped by the system in your early 30s you might as well get rich when you get out nearing 35. Also doesn't hurt that medical school is unsubsidized (unlike other countries) which means residents work the 80 hours a week for 30k a year while having 200,000 of debt.
Bottom line is that its complicated but increasing residency spots would help.
This is not a new problem and it was not caused solely by The Affordable Health Care Act.
I know you liberals are comfortable with fascism, but here in the United States you can't force people to become doctors. It is a ridiculously grueling process and the only way you will be able to get people to enter that profession is by making sure the incentives are there.
And yes, when I say "incentives" I mean the fact that once they make it through all the schooling and training and all those late night shifts at the hospital, there will be some nice financial rewards to be had.
No, tons of people want to be doctors. There just aren't enough spots for them.
I agree completely, Mrs. Liberal policies, Mrs. - especially those which force us to give free healthcare to any illegal immigrant in any E.R. who has the sniffles, Mrs. - is already doing irreparable damage to our health care system, Mrs.
That's a silly statement. I'm sure just about every single low level McDonald's employee in the country would love to be a doctor, probably because they think what they see on TV represents real life.
But fact is that more and more these days, individuals who are qualified to enter that profession, are going in other directions. That ain't the schools' fault.
Thanks for the detailed post Doc. I "knew" was a residency was, but your added detail was informative.
However, my question seemingly still remains. Your post talked about how the system doesnt have enough docs as is, and with more people coming into the system, more will be needed.
Again I ask. How does the government force people to want to become doctors?
The supply of doctors is limited more by those who actually want to put in the time to become one than it is by the system (I would think).
EDIT - I guess the point I am making is increasing the HC rolls by 30M people would increase the number of doctors needs by some order correct?
The ratio in the US is 390:1, so all things being equal, you are talking an addition 77K doctors.
Am I to believe that there are 77K people who can't be a doctor simply because of "class size"/residency?
Again - anything is possible, but I still stick to my original thesis that the supply is limited the number of people who actually want to be a doctor than it is by the "class/residency limits". And increasing class/residency levels wont close the gap.
EDIT2 - Link below shows # of Med School Applications since 1982. The max in that time frame was 47K in 1996. i.e "the number of people who want to be doctors"
Assuming Med Schools accept 40-50% of applications (nationally) a year, you are talking roughly 20K "new docs" entering the pipeline each year, assuming they all graduate.
Again, it seems that it more a supply issue dictated by population desire to be a doctor, than it is by the system controlling the number that get there.
77K new doctors, for 30M people, would almost take the two highest years (in terms of apps) to fulfill.
Link - https://www.aamc.org/download/153708/data/charts1982to2012.pdf
Isn't that the point? Merely having coverage doesn't guarantee care. You need providers for that. I guess primary care providers didn't get the memo that health care is a "right".
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