Universal health care and the physician shortage

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The presidential candidates are fighting over who would do the most to increase the number of Americans with health insurance and expand access to care. But their plans don’t ensure that there will be enough doctors and nurses will treat all those new patients, argues a report expected to be released later today . . .

. . . And, as the report notes, some in Washington are acting on the issue. Democratic Sen. Joe Biden has proposed increasing medical residency programs in states with low population-to-resident ratios.

The solution is not more residency slots, nor opening more medical schools. This will simply increase the number of specialists, which would not be helpful.

What is needed is to give medical students a real, financial, reason to choose primary care over a specialty. Reforming how physicians are paid, closing the salary disparity between primary care and specialists, and total forgiveness of student loans for those who choose primary care would be a good start.

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  • Anonymous

    Loan forgiveness? I have to disagree. There is no free lunch. Take the handout, and they will own you. Rationalizing payment would be adequate.

    Anyway, what makes you think there will be so many new patients? Uninsured people get a lot of care also. If people don’t have to go to the county clinic, then those clinicians are free to see them whereever they are going.

  • Criminallopath

    If it is a “problem” then why give them a choice. Want to be a provider? You go into primary care. QED.

    Or… we finally get rid of the primary care boondoggle and turn it over to the midlevels. They are going to do the same thing that is being done now… order tests and refer. Heck, one doesn’t even need a midlevel for that.

  • Anonymous

    First of all, you have to be certain there is a problem with primary care access. I don’t believe the public perceives this to be a problem. I do think there are problems in some areas with access to specialists.

    Rheumatology, endocrinology, and neurology all come to mind. And please tell me how many choices outside of a major medical center you have for subspecialty care like pediatric neurology or pediatric ophthalmology?

    The fact is that emergency/urgent care clinics and specialists increasingly provide the bulk of medical care. This is true for wealthy and poor alike. Outside of specialist’s offices, more and more care is episodic/acute. And this may be the most cost-efficient situation in many cases.

    Preventative and primary care actually can be very expensive when you factor in all the visits, tests, and medications routinely prescribed for marginal or asymptomatic conditions. So go to the doctors office. Have a cold? Have a Z-pack even if it is a viral illness. When was the last time an antacid was recommended instead of Nexium for heartburn? Until recently, how about some Vioxx for that joint pain rather than a trial of higher dose ibuprofen? Trouble sleeping? Skip the OTC benedryl and move on the your choice of high priced RX. Got Alzheimer’s? Are you sure that costly medication is really helping? And be sure to follow-up adding additional layers of cost. Have you ever wondered how your patients manage to even ingest that long list of medications they tote and just how long they would live without most of them? How cavalier was the physician in prescibing because the patient expected a presciption and/or you needed to get on to the next patient?

    But don’t miss your mammogram, colonoscopy, or prostate exam. And two of these require a specialist.

    We are all going to die; delaying the inevitable while maintaining functionality in an economically justifiable manner is the goal.

  • Anonymous

    “why give them a choice”

    Because freedom is still worth something–even dying for and killing for.

    If you think central planners should dictate occupations, then go live somewhere that operates on that principle.

    Cuba is close and would love to have you.

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