Doctors try to fight the insurers . . . and lose

The first poster completely fails to understand the reasons for the problem of physician supply.

The projected shortfall is a guess. Given that most of the recent guesses about projected needs for numbers of physicians in the U.S. have been wrong–and not by just a little–any predictions of dire shortfalls should provoke at least a little caution if not outright skepticism.

The numbers of residency slots are controlled not by “the docs’ or by the AMA or other boogeymen or conspirators but by the U.S. government which provides the financing through CMMS, and by the ACGME which with the various specialty bodies sets standards for the quality of residency programs. Indirectly, how many residents a particular program can train is based on the ability of that program to meet the minimum standards for patient encounters, case complexity and surgical experience. A teaching program can’t expand its program just because some prognosticator predicts a future shortfall; there have to be enough patients right now to provide adequate training for the residents being trained. All the USATODAY articles in the world won’t change that.

Artificial scarcity? That is doubtful. The scarcity is natural, wrought not by unreasonable admissions standards but by educational cost and length of training and by attractive career alternatives that are cheaper and come with lower opportunity costs and better living conditions. Determined applicants who meet the reasonable standards for medical school admissions find their way to medical school. They might not get a slot in the ultra-competitive and lower-cost University of California medical schools, but they generally get in somewhere. And the argument that supply is not being met unless seats go empty–something I have read here before–is patently ridiculous. All that would mean is that working conditions had become so poor as to fail to attract sufficient candidates. Opening up new medical schools only to have to drop standards so that the classes would be full enough to prevent the predicted “shortfall” is not an answer. Medicine should be and should stay an attractive profession whose members come to their place by honest but real competition. That is the only path to quality.
If you want more good doctors, then pay them better and make the working conditions better; that principle seems to work in every other occupation. I have yet to hear anyone argue convincingly why it shouldn’t apply to medicine. Only then when you have the surplus of well qualified candidates should you be cutting ribbons and digging holes to build new schools.

Reducing the cost of medical education has been the task of most state governments since state-affiliated medical schools were first chartered. Their support is what makes the tuition difference between state and private schools so significant. But many states are cutting back what they are subsidizing, a practice that would seem to stifle not grow pool of available doctors. All the good intentions on the part of doctors won’t change that. Private citizens doing their public duty on election day and April 15th are the way that will change. Good luck with all that.

Medical tourism is and will remain nothing more than an oddity. It is an inconvenient and unattractive solution to a difficult problem. Just like the need for housing and food, the need for medical care will remain fundamentally a local one that will require locally-available solutions. I need only reflect on my own practice experience. People who won’t drive sixty miles for care at one of the world’s best medical universities won’t drive sixty miles to the airport to get on a plane for Mumbai either.

Well, looks like ADD has found a new voice.

The commenter above does not understand. The reference to competition has to do with applying to medical school. What does that have to do with “transparency,” what that is supposed to mean? Nothing, unless the anonymous poster thinks academic applications are the business of the public, which they are not, or at least not anywhere else. Why you think that medical school applications have anything at all to do with anything else you mention is a relationship known only to you.

“Transparency,” in what, in state board of medicine proceedings? Those organizations’ operating rules are established by state laws. Write your state representative if you don’t like that. Or maybe you mean transparency of court records in medical malpractice cases. Usually those are the purview of state law and the actions of the court judge memorializing any settlement agreement. Don’t like it? Write your congressman. What records “available” to consumers, then? In hospital medical staff proceedings? Those are private organizations, generally, they aren’t required to publicize anything unless action triggers reports to the National Practitioner Database. And access to that database is defined by law, not by “the docs”. Again, if you think you have a right to that information, write your congressman. But imagining that there are secret files somewhere that give a Consumer Reports overview of medical providers is paranoid raving.

The suggestion that medical error is among the top ten causes of death is based on what, exactly, sensational press releases of methodologically flawed “studies” done by the IOM? And how that has anything to do with medical school applications is an explanation I just can’t wait to hear.