Why physician charity care is declining

Chris Rangel with a few ideas:

Part of the reason is that there are few if any protections against liability in treating a population that tends to be less healthy, have more bad habits (obesity, smoking, alcohol, drug abuse), and be less complaint with treatment and follow up. Ergo, they are at higher risk of bad outcomes and bad outcomes tend to lead to lawsuits regardless of any actual malpractice. Remember the old medical school adage; “No good deed goes unpunished.”
But most of the reasons have to do with time constraints. When a physician is doing something for free then during that time they are not creating cash flow to cover their clinic overhead and pay down their student loans, which average almost $120,000. So doing charity care means taking a cut in their take-home pay. Again, no good deed goes unpunished.

Comments

Anonymous
One of my partners says he does charity care – he considers that seeing patients and accepting what medicare or their insurance will pay constitutes charity.
Anonymous
Medicare and Medicaid is charity care. If there was a nationwide exclusion of liability for charity work then I am sure more doctors would do it.
Criminallopath
How quaint to have a system in which the charity of the providers is relied upon instead of actually training enough providers to meet the existing demand.
Anonymous
“…instead of actually training enough providers to meet the existing demand.”
Obviously charity care is still relied upon in the legal field for inner city clients that have no money. I don’t think there is a shortage of lawyers. What makes you think that if more physicians are trained it will lead to more charity care? Your logic is convoluted as usual.
Criminallopath
Charity care in the legal field? Now that is an oxymoron if there ever was one. Taking a case on a contingency basis involving an indigent client would hardly be considered a charity case. Neither would taking an indigent client on cases in which the plaintiff serves as little more than a place holder for a lawyer who is attempting to make his/her name by having new case law established. Now, let us say that we increase the supply of providers by a nice large number such as an order of magnitude (10x). Not only would there be more competition between providers for patients (thereby reducing costs) but providers would also have to serve currently unserved/underserved markets such as rural/urban areas if they wished to remain in practice. Finally, we don’t rely on the charity of the police or fire department and we should not have a system in which the charity of providers is what is relied upon for access to basic health care services.
Anonymous
Jee Wiz… criminallopath is about the most negative person I have ever come across on the Internet. If he hates healthcare, doctors, etc. so much then why does he hang around on medical blog? He comes lookin’ for a fight everyday… must be a trial lawyer who can’t stand not being in a fight at all times in his life: personal and professional.
Anonymous
“Now, let us say that we increase the supply of providers by a nice large number such as an order of magnitude (10x).”
And by what form of supernatural event is that supposed to happen? All of the sudden there will be ten times the numbers of applicants? There certainly aren’t that number of unsuccessful applicants left over from the medical school applications process as things are. So where will all those interested, (and hopefully bright and qualified, although I very much doubt that) candidates come from? And what will attract them, having flooded the market with underemployed providers who presumably will have to lower their prices to what, below costs? Will we count on press-gangs to haul the wavering would-be students aboard the H.M.S. Allopathic?
As an economist Mr. Criminallopath, you are adrift yourself. Pray you beach yourself on Fantasy Island.
Anonymous
If current applicants to medical school were knowledgable, rather than idealistically naive of the abyss into which they enter, we would not fill existing training slots. As a matter of fact, many residency training slots go unfilled, or must be filled by foreign medical graduates.
Anonymous
It has been well documented that healthcare costs are directly related to the number of physicians. Therefore, increasing the number of physicians, if it can be done, will lead to higher costs. With healthcare spending currently in the USA at 16% of GDP, I suppose the criminal would like us to go higher, maybe 25%??
Criminallopath
Anonymous 1:44 –
My order of magnitude indication was just a number put out there for discussion (use whatever number you see fit – 2x, 3x, 5x, etc). What is clear is that medical school admissions remain the most restrictive of all professional schools and with their low rates of admission turn away many students that are capable of dealing with the academic rigors of the training process. Oddly enough, we have a bit of a double standard when it comes to the training process. We are overtly restrictive when it comes to domestic training and yet we allow providers from foreign countries the privilege of practicing domestically with the passage of the board exams and the performance of a residency. Given that these foreign schools are not nearly as restrictive as our schools domestically and given that the onerous hurdles (e.g. affiliation with large research institutions) are not present for a number of foreign countries from which we import providers from… we have one of two options. The first is that our training system is overtly restrictive if those trained at foreign schools are able to pass our practice requirements and perform in a competent manner or our practice requirements are lax and we are licensing incompetent providers. I opt for the former. Unfortunately, under the auspices of egalitarian claims such as training only the best and brightest, which by the way is what is sold to the public, but is clearly not the case if one even peruses the Flexner Report, we have created a bottleneck in the supply side of the equation. The underlying goals of the Flexner Report have clearly been met. Provider after-expense compensation rates are high, legislative feat has limited competition and a credulous public that use idolatry instead of logic when evaluating the health care “crisis.”
One would think, given the bill of goods that is sold and bought by the general public, that people would be attracted to the field of medicine (as they are in other first world countries) out of a primary desire to provide health care. I wish I knew where the exact balance was between the various issues and interest groups, but what I do know is that it is a travesty when providers can blackmail an entire regional populace with threats of patient abandonment unless they are given special privileges, when the potential removal from practice of a single barebacking incompetent neurosurgeon creates an “access to care crisis” and when rural/urban areas have no or limited access to care because there exist an insufficient number of providers such that the basic supply/demand economics ensures that these areas will be served if the providers wish to stay in business.
Criminallopath
Anonymous 2:42 –
What you have posted is true… with a a few caveats. Those include but are not limited to still having an insufficient number of providers to engender competition between providers, keeping the current reimbursement system in place,keeping the current legal model in place, etc. Reforming the system is a multifaceted problem.
Anonymous
“…insufficient number of providers to engender competition between providers, keeping the current reimbursement system in place…”
Not sure what you are trying to get at here. My original anon 2:42
statement remains fact. Gendering competition among physicians will not lower costs or reimbursements. The reimbursement rates are set by Medicare. The bottom line is that the more physicians you have the more testing and procedures will be done, therefore the higher healthcare expenditures will be. Again, do you want the current 16% of GDP or 25%, your choice.
Criminallopath
More physicians = more testing and procedures holds true because of the current system. I accept neither the 16% or 25% GDP for health care costs – particularly with the coverage and quality that is shown by the system today.
Anonymous
I agree that coverage needs to be improved to insure everyone against catastrophic medical expenses. The MA, MD, and CA plans will hopefully do this with their HDHPs.
As far as quality goes, medical error rates in hospitals are improving with adoption of new protocols, electronic medication orders, etc. There is good news from the ACS today revealing that cancer death rates are down for a second straight year. We may be turning the corner on cancer due to improved lifestyle changes, better screening, and more advanced treatments.
http://caonline.amcancersoc.org/misc/cancerstats2007.pdf
Anonymous
I am on the admissions committee of my medical school. Our school was asked to increase enrollment and the school said yes.
Against my protest WE ARE REALLY STARTING TO SCRAPE THE BOTTOM OF THE BARREL to fill the spots.
And Mr. Criminal wants more substandard doctors out there?????????
Criminalopath is a friggin idiot.
Criminallopath
Anonymous 7:52 –
One would hope that you put a bit more thought, work and objectivity into evaluating perspective students as you are into your responses here. If your issues is “substandard doctors” then you would have few problems with permanent revocation of licensure (comity on this issue) for these “substandard doctors?” Also, would you push to have all foreign trained providers that have been trained at the “Tijuana Techs” of the world removed from practice and stripped of their licensure? I say give it a few years and see how many of these “bottom of the barrel” students make it through the pass/fail/honors medical school grading system.
Anonymous
If you knew more about medicine Criminalpath you would know that the “shortage” of providers has more to do with residency positions than it does for admission to medical schools. You can put out 10x the medical students it doesn’t matter. We don’t have the infrastructure and residency positions to train them. We are putting out less residents now than we did 10 years ago partially because there is no funding for more positions since 1993. Only 21 cents of every healthcare dollar is spent on physician payment in our “egalitarian” system that we have set up. Man, you like that word. I have seen it no less than eight times on this site. It seems to me that your focus on how to solve this horrible system that doesn’t give us the “quality” you would like for what we spend would be better spent on the 79 cents of every healthcare dollar we spend
Anonymous
Criminal,
Of course I would be for revoking licensure for clearly “substandard doctor” including those from “Tijuana tech” if they were substandard.
So what is your point? Oh I forgot, you don’t have one. That is why usually no one bothers to comment on your stupid postings.
Criminallopath
Your juvenile insults aside and your inability to form a logical argument aside (god help the students that apply to whatever school allows one such as yourself to be on the admissions board), complaining about the quality of American medical school applicants and having an overtly restrictive admission policy while allowing Tijuana Tech graduates to enter the US to practice the “art” of medicine is grossly contradictory. Domestic students that end up at the Tijuana Techs of the world are those that were eschewed by the domestic schools (the bottom of the barrel types) and yet, after receiving their training at schools that don’t have a research arm (imagine that – another not needed burden) to speak of they are still allowed to enter this country and practice medicine after passing the boards and completing their residency. Apparently, counting integers (besides logic) is also a weak suit of yours. Look at the comment numbers and you can take your time to disprove your assertion.
BTW, I am all for increasing the number of residency slots by reworking the existing federal funding structure for health care to finance the expansion.
Anonymous
Medical School admission is not overly restrictive. Judging from the quality of students I see now, it is not restrictive enough.
If someone goes to Tijuana tech, passes licensure examinations (which btw are harder than what US grads must pass), completes a residency, has English language skills that are tolerable for patients, MORE POWER TO THEM.
Again, you have no point despite countless hours trying to make it on Kevin’s Blog.
Criminallopath
The validity of my points does not rest upon your inability to understand them. The few minutes that I spend here apparently takes more skin off of your back than mine.
Anonymous
I’ll tell you all what. I am U.S. born and attending a foreign medical school because I had a stomach ache the day of the MCAT and got a 6 on the physical part and a 12 and 13 on the verbal/Bio. Anyways, I’ve aced everyone of my courses so far and rarely miss a question on the USMLE practice exams. So what if I was educated in the Carribean? Some pricks with 4.0′s in music compared to my heavy undergrad science expertise are not anymore qualified than I am…
Anonymous
I forgot, “I’m bottom of the barrel for my 6 physical.”

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