Health Care Reform: Where will the doctors come from?

Viva Le Mexico!

It is important to remember that the majority of medical care can be performed by well trained and experienced Physicians Assistants and Registered Nurses. There are many “lower level” procedures that can and are treated by medical providers who are not fully certified Medical Doctors.

I don’t have hard numbers on this, but from my experience in and around the system, and from friends who work at/in various pieces of the health care machine, there is so much waste (not fraud or corruption- just waste- duplicated efforts, unnecessary tests and forms, etc, etc, etc) that a lot of people within the profession perfectly qualified to give accurate medical advice and care spend much more of their time doing anything but that.

That is to say, any improvement to the efficiency of the system will free up more caringperson-hours than any manpower drive could.

Yeah, i don’t think anyone’s going to school to be a doctor anymore. They’re all becoming Hippie plant huggers.

maybe we can convert some lawyers…

They’ll come from medical schools, just like all doctors do. There’s no shortage of people who are highly qualified and willing to be doctors. Our economy runs on a concept called ‘supply and demand’. If the demand increases, so will the supply.

people forget, this is not going to be a miracle solution overnight. it’s going to take time for universal health care to become as effective and beneficial as say Sweden’s, system.

For a couple years there will be kinks to work out, every country is different, so while you can get much help by building off of successful health care systems in other countries, it’s very difficult to project the proportions accurately, as well as specific situations that are often times unique to a specific country.

Health Care reform is needed, that much is very certain. I think many people are against it because things are already hard, things have changed a lot already, that to prospect of something getting any worse is a very scary one. But a majority of what’s in the introduced bill are steps in the right direction. There will be bumps, though the bill is designed to gradually slide into universal health care rather than jump straight into it, it will still be a little coarse. but at the end of the day, it will be better than what we have now by a long shot.

I don’t have access to the evidence, but studies have shown that doctors in some areas order unnecessary tests and procedures to protect their bottom line. Maybe if they had more patients to take care of, they wouldn’t need to resort to these kinds of actions.

@ABoyNamedBoobs03 the system in Sweden saved my son’s life

@ABoyNamedBoobs03: lol, do you study French? “Le” isn’t a word in Spanish…I think you mean ”¡Que viva Mexico!”

Let us say Bush(or Clinton) decided to make a lot more doctors 8(16) years ago. Free school for doctors that are awesome. Shilolo and people like him could go to school and focus on being a good doctor and not worry about debt.

More doctors. Sure they would have made less. But they would be without loans so it would kinda work out.

We knew this was coming. It is fucking insane that we didn’t prepare for it.

One of my good friends is a doctor and says doctors now just don’t make what they did in the “old days” before HMOs. It is hard to be sympathetic knowing that they must make well over what my family does, but I understand that their student loans can be financially crippling – especially in the earlier years. She is in her 40s and still paying hers off. Who is going to want to pay for all of that medical school if they are going to make even less? I wouldn’t.

According to the National Center for Health Statistics, there were 921,904 doctors of medicine in the US, but only 766,836 were “active;” in principle, this should leave 155,068 doctors to come back to the practice, eh? http://www.cdc.gov/nchs/data/hus/hus08.pdf

Why do they leave practice? Perhaps the Physicians’ Foundation survey
provides a clue:

49% of physicians – more than 150,000 doctors nationwide – said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely.
63% of doctors said non-clinical paperwork has caused them to spend less time with their patients
94% said time they devote to non-clinical paperwork in the last three
years has increased

“Patient relationships” rated highest on the list of things physicians find satisfying about medicine, while “reimbursement issues” and “managed care issues” rated the highest on the list of issues physicians find unsatisfying about medicine.

http://www.physiciansfoundations.org/usr_doc/Key_Findings_for_Website.pdf

“The survey asked physicians for their written comments regarding what
they would tell policy makers and the public about current medical
practice conditions in the United States. Some 4,000 physicians put
their thoughts on paper, many writing at length and some even submitting
essays or books, while others confined themselves to one-word editorials
such as “Help!”

The great majority of letters indicated that physicians have deep misgivings about the practice of medicine today and the future of the profession. Many feel the profession has been devalued. Many are tired of doing battle with third parties that rob them of time, energy and empathy.”

http://www.physiciansfoundations.org/usr_doc/PF_Survey_Report.pdf

While the survey doesn’t say so, I get the feeling that the leading cause is the vast diversity in how each insurance and government plan requires its paperwork, and the widely variable conditions for reimbursement.

In short, if all they have to deal with is one kind of insurance, one set of rules, many of those who are disillusioned with medicine may come back, or stay in if they are thinking of quitting.

Well, in the UK everyone has health insurance and there are 2.2 doctors per 1000 citizens. In the US there are more doctors per capita, i.e. 2.3 so the conclusion is: it can be done. See statistics below. Maybe a more efficient organization is needed. Some tasks can be delegated. A doctor needs to be a good manager too. Additional doctors will graduate or immigrate from other countries. Germany has 3.4 doctors and everyone has health insurance.

Number of doctors per 1000 citizens:

1 San Marino: 47.35
2 Cuba: 5.91
3 Monaco: 5.81
4 Saint Lucia: 5.17
5 Belarus: 4.55
6 Greece: 4.4
7 Russia: 4.25
8 Italy: 4.2
9 Turkmenistan: 4.18
10 Georgia: 4.09
11 Lithuania: 3.97
12 Belgium: 3.9
13 Israel: 3.82
14 Andorra: 3.7
15 Uruguay: 3.65
16 Iceland: 3.62
17 Switzerland: 3.6
18 Armenia: 3.59
19 Bulgaria: 3.56
20 Azerbaijan: 3.55
21 Kazakhstan: 3.54
22 Czech Republic: 3.5
23 Austria: 3.4
23 Germany: 3.4
25 France: 3.37
26 Portugal: 3.3
26 Sweden: 3.3
28 Korea, North: 3.29
29 Lebanon: 3.25
30 Hungary: 3.2
30 Spain: 3.2
32 Malta: 3.18
33 Estonia: 3.16
34 Norway: 3.1
34 Netherlands: 3.1
34 Slovakia: 3.1
37 Latvia: 3.01
37 Argentina: 3.01
39 Ukraine: 2.95
40 Denmark: 2.9
41 Ireland: 2.79
42 Uzbekistan: 2.74
43 Luxembourg: 2.7
44 Moldova: 2.64
45 Mongolia: 2.63
46 Finland: 2.6
47 Kyrgyzstan: 2.5
47 Australia: 2.5
47 Poland: 2.5
50 Croatia: 2.4
51 Cyprus: 2.34
52 United States: 2.3
53 Slovenia: 2.25
54 Qatar: 2.22
55 New Zealand: 2.2
56 United Kingdom: 2.2
57 Macedonia 2.19
58 Canada: 2.1

http://www.nationmaster.com/graph/hea_phy_per_1000_peo-physicians-per-1-000-people

I believe there are enough doctors here already. I have heard that there are too many specialists and not enough primary care physicians, but there is so much disinformation coming out of the U.S. political right and the insurance lobby that I don’t believe everything I’m hearing.

I do believe we need to implement a better system for training doctors in the U.S. Most leave medical school with an enormous amount of debt. I’ve heard of initiatives in, for example, rural areas to attract more doctors by assisting with that debt, and I think it’s a good idea.

Doctors will still make good salaries. If you think some will leave the profession or not go into it, because they will make only $300K instead of $600K then I guess they were not doctors because they cared about people and medicine. Some parts of the profession like GP’s and Pediatric MD’s don’t make much money now, so I think they will see little change or maybe actually get paid more. I was talking to a surgeon the other day who is annoyed that he makes $700 from medicare for a particular surgery he does, when he used to make $6000, but now will discount it for self pay to $3000. The surgery takes 1–1.5 hours. Vision correction surgery used to be $5000 for both eyes, not I think it is more like $2500 now. Honestly, if docs were not over charging to begin with maybe we would not be scrutinizing the profession so much right now. Certainly, not all parts of the profession have been greedy, but a lot of it has.

I want doctors to make a really good fair salary. I value the years it takes to become a doctor, and the service they provide, but if you get too greedy eventually the bubble pops. Doesn’t matter if you are GM, Wall Street or medical care.

@mattbrowne I think the biggest lesson from those numbers are that the number of doctors is not the end all be all of quality health care. places like Cuba, North Korea, Azerbijan, etc. have more doctors per capita than places like Sweden, switzerland and as you mentioned, the UK, yet their health care plans are far superior in virtually every fashion.

It’s quality over quantity, you could have 200 doctors per 1000 patients but if they’re inferior medically and lack managerial ability then it’s all for nothing. Most of the doctors in the US are quality physicians, (comparitively speaking), so I think that after a little bit an an adjustment period to get used to the new influx in volume, our current number shouldn’t be too problematic, and I expect the number of doctors to increase steadily over the next five years or so, because it will be realized that the more quality doctors that we have, the smoother individual experiences as well as kinks in general, will go.

As I mentioned before, the way the current bill is set up, America won’t be jumping head first into total reform, rather we’ll sort of slip into it like a hot bath. As our needs for more doctors increases, I imagine there will be new incentives from the government to go into certain medical feilds.

@ABoyNamedBoobs03 – I general you are correct. More doctors per capita does not necessarily lead to better quality, but sometimes it does. Since you mentioned Cuba, infant mortality rates in Cuba are lower than in the United States, see

http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate

An example of waste in the system that could be fixed with electronic medical records.
My mother in law has been falling a lot and they don’t know why. She was in the hospital on the pulmonary floor with all sorts of monitoring and they concluded it wasn’t her heart. They sent her home, she got really sick and took her by ambulance to a different hospital. They treated her for meningitis and sent her to skilled nursing for recovery.
She tells the skilled nursing doctor that she just wants to find out why she is falling. The skilled nursing doctor orders a whole bunch of pulmonary tests to rule out a cardiac cause. If the skilled nursing doctor had known about all the tests that had been done in the hospital 2 weeks earlier he wouldn’t have repeated them. When I reminded my mother in law that she had worn that monitor durring her entire previous hospital visit she said “I must have been so sick I didn’t remember.”
How much money is wasted by repeat tests every time we see specialists? This is just one example. I cantrell you how many MRI’s and CAT scans this woman has had.

If demand goes up and supply is constrained, health care will cost more. If there is excess supply, then if demand goes up, health care may not cost more.

Will demand go up? I believe that overall, it won’t so much go up as switch from hospital settings to primary care settings. Demand will go up for primary care, but down for tertiary care. The supply of physicians may switch over to internal and pediatric medicine as the demand for those physicians goes up, and salaries go up as a result.

As demand for primary cares rises, I suspect that productivity in primary care will rise. New information systems are being installed and there is and will be more expanded use of less expensive providers, such as nurse practitioners. And, as others point out, as the incentives for defensive medicine are reduced, demand for care will be reduced.

So many factors. So difficult to predict the overall impact. It will take care of itself, and we will deal with the consequences as they become apparent. In any case, without a public option, health insurance cost won’t go down (due to little increase, if any, in competition between health insurers), and not so many new folks will be covered and demand may not rise very significantly.

Even if there were a public option, demand would probably increase slowly, if at all, due to the maintenance of the current method of financing health care. Without a single-payer system, little will change. It’ll all be cosmetic. I don’t expect much change from any of the current proposals. Republicans and conservative Democrats have effectively squelched any meaningful or effective health insurance reform.

In fact, under the current proposals, health spending is likely to increase even more. The savings will be illusory, and the system will not achieve the results that are imagined. Republicans will say “we told you so,” and urge a return to the current system. They might win, and remove the attempts at universal insurance. Eventually, this will work even less well, and the pendulum will swing the other way. Whether it will ever swing far enough to get a sensible universal insurance program that is financed in an efficient way, I can not predict.

Doctors will come from the place they always did: people deciding that there will be job satisfaction and steady income from working as a doctor.

@daloon I rarely need or get help from a primary care doctor, unless you are going to include GYN as primary. Do you? Do you include a GYN as primary, and do you get the majority of your healthcare from primary care? I am honestly nervous about this primary care talk, it sounds a lot like the HMO fiasco. Generally, I wind up at a specialist, and skipping the step of primary care seem to be more cost effective to me. If you mean primary care to have fewer going to the ER that is a different thing.

I could always use more work…
(@La_chica_gomela you’re right about “viva mexico” in that @ABoyNamedBoobs03 misused the french word “Le”... the only reason this sticks out to me is that in Mexican medical schools students are taught in the tradition of French Medical Schools since the 1900’s… it may not be related.. it just stuck with me).

@JLeslie I believe your Ob/Gyn would be considered primary care because they are the person who provides continuity of care. Here’s a definition from MedicineNet:

Definition of Primary care

Primary care: The “medical home” for a patient, ideally providing continuity and integration of health care. All family physicians and most pediatricians and internists are in primary care. The aims of primary care are to provide the patient with a broad spectrum of care, both preventive and curative, over a period of time and to coordinate all of the care the patient receives.

As to jumping right to a specialist (secondary care)—you can only do that if you are familiar with symptoms you have, either through experience or through research. For many conditions, you probably have no idea of which specialist to go to, so you go to your gynecologist (or other primary care physician) first.

Most people are less knowledgeable about health than you are, I suspect, and a lot of people who end up getting care in the ER (tertiary care) could easily have gotten it much more cheaply and effectively in a primary care situation. You don’t need to have defibrillators and expensive diagnostic machinery on hand to diagnose a flu or a tummy ache.

@daloon OB/GYN is secondary care as they deal with a specific range of diseases and have a very detailed specialty. A GP or family Physician can also help with many gynecological issues and would in many instances have a better understanding of your overall health issues and how they are all connected as opposed to a specialist whose purview is narrower. Continuity of care deals with overall health and not one specific organ system. If you need to frequent an OB/GYN’s office for a specific condition that’s fine, but in many instances a GP or Family physician will do just fine.

@daloon not being argumentative here, just making some statements. GYN’s vary greatly. I have had ones who listen to my heart and run basic blood panels, and ones who don’t. This was a problem in some HMO’s that you needed to get a referral from primary for a GYN visit if you were going more than once in a year. Most women can decifer when they need to go to the GYN, and none of us would go for the flu or a tummy ache I don’t think. I don’t go to the doctor for the flu at all, it is ridiculous 90% of the time. So, I don’t typically view my GYN as coordinating my care. Just thinking aloud.

I guess what I am saying is I don’t want to have to go to my primary to get approval to go to my GYN. Waste of my money (two co-pays) and my time.

@JLeslie: In my experience, when I need a referral to a specialist, I call up my doctor’s practice—I don’t even need to speak with him directly—and they manage the paperwork. It doesn’t cost me a second co-pay, and if the specialist is connected to their computer system, they can even schedule my appointment.

It can depend on insurance and your relationship with your gynecologist. In some cases, ob/gyns do not require a referral and in others they do. In some cases, the only doctor a woman sees is her gynecologist. My wife mainly sees her gynecologist. When she needed a rx for welbutrin, she called her gynecologist to get it. So, while a gynecologist is technically a specialist; in some cases they serve as a primary care physician. However, I think they are probably more often thought of and serve as secondary care. I think I was generalizing from limited experience. oops

Having said that, it’s still less costly to see a specialist first, rather than entering the medical system through an ER, except, of course, for real emergencies. For this reason, some insurance companies have stopped requiring referrals for specialists. I guess a lot of people now have enough experience to know when to see a dermatologist or a sleep doctor or a gynecologist, or they can go when the primary care physician recommends it without having to get an official referral.

everything is screwed up.. and nothing is ever perfect. that’s life and we need to stop bitching about it~ I bet in a few weeks, everyone is going to forget about this health care reform and move on to another topic to bitch about

Yes, let’s certainly not be involved or informed about our government and what laws are being discussed, because they probably won’t even affect our lives. We’ll just forget all about our health.~

@azhaiaziam: everything is screwed up, and nothing is ever perfect, but it is still our obligation to un-screw things as much as we can, and improve them as much as we can.

If you don’t care, I advise you to close your eyes, put your fingers in your ears, and hum as loudly as you can. Oh, and while you’re at it, pray you don’t get sick.

I do care but how much is it in our hands.. we live in a society where politics and the rich have the most impact. We can’t blame one president for trying to change things because it is not just him that purpose this health care reform. He is trying to speak for the people and make changes that we aren’t in favor for because it is going to come out of pockets but, it may help the future generations ahead of us. I am in med school and studying to become a doctor and I do have my concerns about the out come of this health reforms because many doctors already have to pay for student loans, taxes, and protection insurance for their practice. I also do have concerns on social security for the elders and how it is going to run out.. I don’t think this health reform is going to come over night or anytime soon. Just remember, a new president in the future can always change rules and regulation for example Clinton put stricter laws to keep the environment cleaner with regulations and how Bush took it away,, So don’t be so stressed about it.. Just vote for the next president that you think will do what you want.

@JLeslie Salary???? My friend, doctors, in the private sector, own and operate their own private practices like businesses, as they should. They don’t get salaries, they get what’s left after all the employees and malpractice insurance premiums, and equipment is paid for. That’s called a Profit. I’m not a doctor, but I do own my own business and the very best way to shut me down or eliminate my desire to produce is to give me a friggin salary…..ie, let someone else tell me how much I can make. Do you know when medical costs in the US began to rise like a rocket lifting off? If was the year Medicare was passed, 1966. Not a coincidence.

Doctors can opt out of accepting Medicare and take private pay. Would you like to deprive them of that privilege? If you do, you will lose that doctor.

@plethora, they get what the insurance companies say they get and not a penny more.

@plethora I’m not sure exactly what you are responding to, I tried to go back through the thread. I know I have said in the past that Johns Hopkins, Mayo and other well respected institutions have their doctors on salary, and that I don’t like that doctors are compensated by particular services, like if they do more procedures they make more money. Is that what you were referring too. I know two doctors (so obviously that is not a large sample of people) who much preferred working for the military in terms of their ability to be good doctors and not be dictated to by the insurance industry, but they do make more money on the outside I would guess. I want doctors to make good salaries, I am not trying to take huge amounts of money away from them, I just don’t want their incentive for how they choose to treat me to be based on $$‘s I want it to be based on helping me with my health.

@plethora Also about healthcare costs going up, I think it was in the late 60’s or eary 70’s that the UAW fought for health care benefits thorugh the company, which they got, and that was the beginning of health insurance as a benefit through out jobs which is an outrage to me. There is no real competition in that, I wind up with whatever insurance my job offers me. It would be like if I bought a Centex home and was only allow to insure with State Farm. I am not saying medicare is perfect, I am just saying there migh tbe more to that state than one culprit.

And, lastly, millions of people every day go to work for a salary.

Part of the reason for health costs going up is that doctors are incentivized to do as many procedures as possible, because they make money per procedure. When paid a salary, they do not have nearly the incentive, and the procedures will be “as necessary” to diagnose and treat the problem.

@laureth , the tendency for doctors to overprescribe tests is labeled “defensive medicine” by opponents of HCR, and they insist it will stop if they succeed in capping malpractice awards.

@IchtheosaurusRex – That’s certainly part of it, for sure. However, if doctors were paid to make people well (salary) rather than by the piece (procedures), it would cut costs dramatically while raising the quality of care. This magazine article (or this blog post summarizing the article and pointing out the important parts) explains why more procedures add expense without necessarily being better medicine.

Simply allowing doctors to talk to each other in consultation would help cut procedures and lower costs. “When doctors put their heads together in a room, when they share expertise, you get more thinking and less testing.” However, most insurance companies don’t allow this as a billable cost.

@laureth Thank you Laureth, you spoke my mind without me having to do it.